A Survey of Vitamin B12 Deficiency in an Elderly Psychiatric Population

1967 ◽  
Vol 113 (496) ◽  
pp. 241-251 ◽  
Author(s):  
R. Shulman
Keyword(s):  
Psychiatric Patients ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Pernicious Anaemia ◽  
Vitamin B ◽  
Cerebral Lesions ◽  
Mental Symptoms ◽  
B12 Deficiency ◽  
The Subject ◽  
Wassermann Reaction

For many years, cases of pernicious anaemia associated with mental symptoms have been described, and interest in these symptoms was renewed following the introduction of liver therapy (Richardson, 1929; Phillips, 1931). Interest later appeared to decline, so that MacDonald Holmes (1956), almost 20 years after the last important clinical review of the subject, could comment with justification that although the cerebral lesions of pernicious anaemia had been recognized for more than a century they were still much less familiar than the lesions which occurred in the spinal cord and peripheral nerves. Since then vitamin B12 deficiency as a cause of mental symptoms has given rise to increasing interest, and this is reflected in recent suggestions that serum vitamin B12 assays should be carried out routinely in psychiatric patients and might be more informative nowadays than the routine Wassermann reaction (Strachan and Henderson, 1965; Hunter and Matthews, 1965).

Serum Vitamin B12 Levels in Indian Psychiatric Patients

1970 ◽  
Vol 117 (541) ◽  
pp. 699-704 ◽  
Author(s):  
V. S. Jathar ◽  
S. P. Patrawalla ◽  
D. R. Doongaji ◽  
D. V. Rege ◽  
R. S. Satoskar
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Peripheral Blood ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Serum Vitamin ◽  
Pernicious Anaemia ◽  
Vitamin B ◽  
Mental Symptoms ◽  
Low Serum

It is known that pernicious anaemia is sometimes associated with mental symptoms which improve following vitamin B12 therapy (Eilenberg, 1960; Holmes, 1956; Smith, 1960). Further, it has been pointed out that such mental symptoms can occur years before the development of anaemia and no definite relationship exists between them and the severity of anaemia (Smith, 1960). Cases have been described with a variety of psychiatric symptoms and low serum vitamin B12 levels without any neurological manifestation or abnormality of peripheral blood and bone marrow. Since pernicious anaemia is due to vitamin B12 deficiency it is suspected that B12 deficiency is responsible for the mental symptoms, and serum B12 assays have been advocated routinely in psychiatric patients (Strachan and Henderson, 1965; Hunter and Matthews, 1965).

Acute Dementia with Delirium Due to Vitamin B12 Deficiency: A Case Report

2002 ◽  
Vol 32 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Vladimir Lerner ◽  
Michael Kanevsky
Keyword(s):  
Case Report ◽  
Psychiatric Patients ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Vitamin B ◽  
State Of Health ◽  
Organic Psychosis ◽  
B12 Deficiency ◽  
Previous State

Objective: Vitamin B12 (cobalamin) is a key component in the catabolism of monoamines. B12 deficiency is associated with various neuropsychiatric disorders and may be more frequent in psychiatric inpatients. The authors describe a case report of a newly admitted and relatively young patient (52 years old) with organic psychosis secondary to vitamin B12 deficiency. No other overt clinical features of cobalamin deficit were observed. Symptoms were resolved with B12 and folate replacement. The patient's mental status remained stable over the 3 months after the treatment. The authors note that organic mental changes were reversible with B12 replacement. Conclusions: The authors propose that determination of serum vitamin B12 and folic acid levels should be recommended as routine screening in all new admissions of psychiatric patients regardless of their age or previous state of health.

Ischemic strokes secondary to vitamin B12 deficiency-induced hyperhomocystinemia

Neurology ◽  
1998 ◽  
Vol 51 (2) ◽  
pp. 622-624 ◽  
Author(s):  
LaRoy P. Penix
Keyword(s):  
Mean Corpuscular Volume ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Vitamin B ◽  
Loading Test ◽  
Schilling Test ◽  
B12 Deficiency ◽  
Recurrent Strokes ◽  
Methionine Loading Test

A 45-year-old woman sustained two ischemic cerebral infarctions 16 years after ileal resection for Crohn's disease. Her evaluation showed an elevated random serum homocystine level, a low serum vitamin B12 level, and an increased mean corpuscular volume (MCV) without anemia. A methionine-loading test resulted in a marked increase in the homocystine levels 2, 4, and 6 hours after the load. A Schilling test demonstrated a malabsorption of vitamin B12. Vitamin B12 injections normalized her fasting homocystine level and her MCV. She has had no recurrent strokes during a year follow-up.

scholarly journals Identification of vitamin B12 deficiency in vegetarian Indians

2018 ◽  
Vol 119 (6) ◽  
pp. 629-635 ◽  
Author(s):  
Sadanand Naik ◽  
Namita Mahalle ◽  
Vijayshri Bhide
Keyword(s):  
Predictive Value ◽  
Characteristic Curve ◽  
Clinical Signs ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Diagnostic Value ◽  
Total Serum ◽  
Vitamin B ◽  
B12 Deficiency ◽  
Specific Uptake

AbstractThe prevalence of a sub-clinical vitamin B12 deficiency in the vegetarians is high. Total serum vitamin B12 concentration alone does not reliably reflect vitamin B12 status. Holotranscobalamin (holo-TC) II is a bioactive B12 fraction promoting specific uptake of B12 by cells and the circulating concentration reflects the intake of B12, whereas total homocysteine (tHcy) indicates the metabolic ability. In this study, we investigated the diagnostic value of circulating holo-TC, B12, folate and homocysteine in vegetarians who were at risk of B12 deficiency. B12-related biomarkers were measured in 119 young, healthy graduate vegetarians. None was folate deficient. As per reported definition, half were B12 deficient; 70 % of males and 50 % of females had low plasma holo-TC concentrations; and 92 % of males and half of females had hyperhomocysteinaemia. None had any clinical signs of B12 deficiency. Receiver operating characteristic curve analysis demonstrated similar AUC at the B12 concentration of 100 and 150 pmol/l when holo-TC (0·777 and 0·784) and homocysteine (0·924 and 0·928) were used as variables. Cut-off value of 100 pmol/l resulted in the highest sensitivity of 77·78 % and specificity of 71·05 % with a predictive value of 19·6 pmol/l for holo-TC and a sensitivity of 82·72 % and specificity of 89·7 % with a predictive value of 21·7 µmol/l for homocysteine. The combination of B12, holo-TC and tHcy improves the diagnostic accuracy at these cut-offs, and we suggest that for the young Indian vegetarians the cut-off for plasma B12 and holotrancobalamin is 100 pmol/l and 19·6 pmol/l, respectively, and for homocysteine it is 17·6 (females) and 27 µmol/l (males) for identifying B12 deficiency.

scholarly journals Reversible dementia, psychotic symptoms and epilepsy in a patient with vitamin B12 deficiency

2019 ◽  
Vol 12 (5) ◽  
pp. e229044 ◽  
Author(s):  
Bruno Silva ◽  
Ana Velosa ◽  
J Bernardo Barahona-Corrêa
Keyword(s):  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Vitamin B12 Deficiency ◽  
Pernicious Anaemia ◽  
Megaloblastic Anaemia ◽  
Psychotic Symptoms ◽  
Vitamin B ◽  
Common Condition ◽  
B12 Deficiency ◽  
Functional Deterioration

Vitamin B12 deficiency is a common condition, typically associated with megaloblastic anaemia, glossitis and neuropsychiatric symptoms. We report the case of a patient presenting with progressive cognitive and functional deterioration, psychosis and seizures, later found to be secondary to pernicious anaemia. Importantly, the diagnosis of pernicious anaemia was only established 5 years after symptom onset and was overlooked even when the patient was under medical care, in part due to the lack of classic neurological and haematological signs associated with the condition. The patient had a remarkable neuropsychiatric recovery after vitamin replacement and psychopharmacological management. We discuss similar presentations of vitamin B12 deficiency found in the literature, symptom reversibility and the importance of its early recognition and treatment.

Vitamin B12Deficiency and Psychiatric Illness

1967 ◽  
Vol 113 (496) ◽  
pp. 252-256 ◽  
Author(s):  
R. Shulman
Keyword(s):  
Causal Relationship ◽  
Psychiatric Illness ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Critical Evaluation ◽  
Pernicious Anaemia ◽  
Neurological Symptoms ◽  
Vitamin B ◽  
Mental Symptoms

Many psychiatric symptoms have been described in pernicious anaemia, including depression, manic excitement, paranoid states, confusional episodes, and dementia. Although vitamin B12deficiency is known to produce neurological symptoms there is much less certainty about its role in producing mental symptoms. Despite this uncertainty, it has been asserted that carrying out vitamin B12assays on psychiatric patients will enable doctors to cure for good severe disabling disease which otherwise may end in chronicity (Edwinet al., 1966). Routine examinations to exclude pernicious anaemia have been advocated for all psychiatric patients (Strachan and Henderson, 1965; Hunter and Matthews, 1965). A prudent preliminary is a critical evaluation of the causal relationship between vitamin B12deficiency and individual psychiatric syndromes.

scholarly journals Keeping a clear head with vitamin B12

2010 ◽  
Vol 32 (6) ◽  
pp. 20-24
Author(s):  
Elena Kazamia ◽  
Katherine E. Helliwell ◽  
Alison G. Smith
Keyword(s):  
Vitamin B12 ◽  
Dairy Products ◽  
Vitamin B12 Deficiency ◽  
Physiological Role ◽  
Pernicious Anaemia ◽  
Increased Risk ◽  
B12 Deficiency ◽  
The Subject ◽  
Enzyme Cofactors ◽  
Essential Enzyme

Vitamins are vital organic micronutrients that are required in our diet because they provide essential enzyme cofactors, and animals have dispensed with the ability to synthesize them. Vitamin B12, or cobalamin, is the most complex of the vitamins, and the elucidation of its physiological role, its structure and its biosynthetic pathways have been the subject of impressive scientific endeavours over the years. Vitamin B12 deficiency leads to increased risk of cardiovascular disease, neurological symptoms and, in the most serious cases, pernicious anaemia. Cobalamin is synthesized only by prokaryotes, so we obtain it second-hand by eating other organisms that have accumulated the vitamin in their tissues. The richest dietary sources are liver, dairy products and also algae, many of which are like animals in that they require an exogenous supply of the vitamin for growth.

scholarly journals Assessment of vitamin B12 deficiency and B12 screening trends for patients on metformin: a retrospective cohort case review

2021 ◽  
pp. bmjnph-2020-000193
Author(s):  
Darby Martin ◽  
Jeet Thaker ◽  
Maria Shreve ◽  
Lois Lamerato ◽  
Kartazyna Budzynska
Keyword(s):  
Retrospective Cohort ◽  
Protective Factor ◽  
Vitamin B12 Deficiency ◽  
Older Age ◽  
Secondary Outcome ◽  
Vitamin B ◽  
Case Review ◽  
Large Hospital ◽  
Hospital System ◽  
B12 Deficiency

ObjectivesOur study investigated the use of vitamin B12 testing in a large cohort of patients on metformin and assesses appropriateness and benefits of screening recommendations for vitamin B12 deficiency.DesignThis retrospective cohort study included insured adult patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin to establish compliance. The comparison group was not exposed to metformin. Primary outcome was incidence of B12 deficiency diagnosed in patients on metformin. Secondary outcome was occurrence of B12 testing in the patient population on metformin. Records dated through 31 December 2018 were analysed.SettingLarge hospital system consisting of inpatient and outpatient data base.ParticipantsA diverse, adult, insured population of patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin.ResultsOf 13 489 patients on metformin, 6051 (44.9%) were tested for vitamin B12 deficiency, of which 202 (3.3%) tested positive (vs 2.2% of comparisons). Average time to test was 990 days. Average time to test positive for deficiency was 1926 days. Factors associated with testing were linked to sex (female, 47.8%), older age (62.79% in patients over 80 years old), race (48.98% white) and causes of malabsorption (7.11%). Multivariable logistic regression showed older age as the only factor associated with vitamin B12 deficiency, whereas African-American ethnicity approached significance as a protective factor.ConclusionsBased on our study’s findings of vitamin B12 deficiency in patients on metformin who are greater than 65 years old and have been using it for over 5 years, we recommend that physicians consider screening in these populations.

scholarly journals Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders

2018 ◽  
Vol 7 (10) ◽  
pp. 304 ◽  
Author(s):  
Emmanuel Andrès ◽  
Abrar-Ahmad Zulfiqar ◽  
Khalid Serraj ◽  
Thomas Vogel ◽  
Georges Kaltenbach
Keyword(s):  
Vitamin B12 ◽  
Prospective Studies ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Cochrane Library ◽  
Clinical Approach ◽  
Oral Vitamin ◽  
Hand Search ◽  
B12 Deficiency

The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption (n = 6), Biermer’s disease (n = 3), veganism or vegetarianism (n = 1), total gastrectomy after Roux-en-Y gastric bypass (n = 2) and Crohn’s disease (n = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 μg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.

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