Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Jun 22;6(1):25.
doi: 10.1186/1753-2000-6-25.

Mood Disorder With Mixed, Psychotic Features Due to Vitamin b12 Deficiency in an Adolescent: Case Report

Affiliations
Free PMC article

Mood Disorder With Mixed, Psychotic Features Due to Vitamin b12 Deficiency in an Adolescent: Case Report

Ali Evren Tufan et al. Child Adolesc Psychiatry Ment Health. .
Free PMC article

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.

Figures

Figure 1
Figure 1
Vitamin B12 levels of the patient at baseline, 2nd, 4th, 8th, 12th and 24th weeks compared to changes in psychometric tests.

Similar articles

See all similar articles

Cited by 5 articles

References

    1. Bolander-Gouaille C, Bottiglieri T. Homocysteine- Related Vitamins and Neuropsychiatric Disorders. Paris: Springer; 2007.
    1. Davoren JB, Davoren JB, Blood Disorders. In Pathophysiology of Disease, An Introduction to Clinical Medicine. New York: McGraw-Hill: Edited by Macphee SJ, Lingappa VR, Ganong WF; 2003. pp. 113–142.
    1. Murray R, Bender D, Botham KM, Kennelly PJ, Rodwell V, Weill PA. Micronutrients, Vitamins & Minerals. In: Harper’s Illustrated Biochemistry. New York: McGraw Hill Medical: 29th Edition; 2012. pp. 467–478.
    1. Durand C. Psychiatric manifestions of vitamin B 12 defiency: A case report. Encephale. 2003;29:560–565. - PubMed
    1. Reynolds E. Vitamin B 12, folic acid, and the nervous system. Lancet Neurol. 2006;5:949–960. doi: 10.1016/S1474-4422(06)70598-1. - DOI - PubMed

LinkOut - more resources

Feedback