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Low Vitamin D Permeates All Stages of Psychosis – April 2015

VITAMIN D AND ITS CLINICAL CORRELATES IN EARLY AND ESTABLISHED PSYCHOSIS

Presented at 15th International Congress on Schizophrenia Research (ICOSR)
Schizophr Bull (2015) 41 (suppl 1): S1-S341. doi: 10.1093/schbul/sbv010
Fiona Gaughran, MD, FRCPsych, FRCPI, FRCP; John Lally, MB MRCPsych; Pooanm Gardner-Sood; Muhammad Firdosi; Susan Moore; Oliver D Howes, PhD DM; Shubulade Smith; Robin Murray, Doctor of Medicine
Psychosis Studies, Institute of Psychiatry, London, United Kingdom

reviewed as Low Vitamin D Permeates All Stages of Psychosis MedPageToday

Background: Evidence from epidemiology, basic neuroscience and clinical studies connects low vitamin D to psychosis. Importantly, given the high rates of early death in psychosis, low vitamin D is also a cardiovascular risk factor.

Methods: We examined vitamin D levels at first onset of psychosis and in the same people 12 months later.

We also measured Vitamin D in a separate sample of 324 community patients with established psychosis.

All comparisons were adjusted for age, sex, ethnicity and season of sampling

Results: At first onset (n=166, 64% male), 18.7% had “sufficient” vitamin D (>20ng/ml), 39.2% “insufficient” (10–20ng/ml) and 42.2% were deficient (<10ng/ml).
Mean vitamin D was 13.64 (SD9.27). Low vitamin D at presentation correlated with Global Assessment of Function (GAF) scores at the time (r=.29, p=0.02) and with poorer function (GAF) (r=.33, p=0.05) and higher Calgary Depression scores (r=-.43, p=0.01) 12 months later. 12 month Vitamin D correlated with 12 month PANSS positive scores (r = -.34, p =.03) and quality of life (EQ5D)(r = .33, p =0.02)

In established psychosis (n= 324, 59.6% male), 13.9% had sufficient vitamin D while 48.8% were deficient. Mean vitamin D was 12.38 (SD 7.3) ng/ml. There was no effect of duration of illness. There were no correlations between vitamin D levels and GAF, PANSS or MADRS, but Quality of life (EQ-5D visual analogue) was lower in those deficient than in those not so, and MADRS scores were higher (p=0.02).

In established psychosis, vitamin D levels were negatively correlated with

  • BMI (r=-0.133, p=0.03),
  • triglycerides (r=-0.203, p=0.001),
  • total cholesterol (r=-0.140, p=0.03),
  • obesity (r=-0.136, p=0.03) and
  • hypertension (r=-0.135, p=0.03).

Vitamin D levels were similar in smokers to non-smokers, but those engaging in low intensity exercise had lower vitamin D than those engaging in moderate/ high activity (p=0.002). Those vitamin D deficient spent less time outdoors than those not deficient (p=0.04).

Conclusion: Vitamin D levels are extremely low at all stages of psychosis. Low vitamin D is linked to quality of life, mood and cardiometabolic risk in established psychosis and highlights the need for holistic management of psychosis. Low D at first presentation predicts function and mood 12 months later. While a more chronic premorbid course may result in lower vitamin D at presentation and poorer outcomes perpetuate the problem, the idea of Vitamin D as potentially neuroprotective in psychosis deserves exploration.

ID: 2118519


See also VitaminDWiki

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