First episode psychosis associated with a 33 percent lower vitamin D in 3 races – Sept 2013

Vitamin D deficiency in first episode psychosis: A case-control study.

Schizophr Res. 2013 Sep 20. pii: S0920-9964(13)00472-6. doi: 10.1016/j.schres.2013.08.036.
Crews M, Lally J, Gardner-Sood P, Howes O, Bonaccorso S, Smith S, Murray RM, Di Forti M, Gaughran F.
Bromley Assertive Outreach and Rehabilitation Team, Oxleas NHS Foundation Trust, London, United Kingdom; Institute of Psychiatry, King's College London, London, United Kingdom.

BACKGROUND: Vitamin D deficiency is seen in a high proportion of people with established psychotic disorders, but it is not known if this is present at onset of the illness. We set out to examine vitamin D levels in people with their first episode of psychosis (FEP).

METHOD: We conducted a matched case-control study to examine vitamin D levels and rates of vitamin D deficiency in sixty nine patients presenting with their FEP and sixty nine controls matched for age, sex and ethnicity. Differences between groups were tested using student's-t tests, paired t-tests and odds ratios for further analysis.

RESULTS: Vitamin D levels were significantly lower in cases than in controls (p<0.001). The odds ratio of being vitamin D deficient was 2.99 in the FEP group relative to the control group. There was no correlation between vitamin D levels and length of hospitalisation in the patient group (r=-0.027, p=0.827).

CONCLUSIONS: We found higher rates of vitamin D deficiency in people with FEP compared to matched controls. Given that vitamin D is neuroprotective; that developmental vitamin D deficiency may be a risk factor for psychosis, and that incipient psychosis may affect lifestyle factors and diet, future studies are required to examine this association further. In the meantime, there is a need for more widespread testing of vitamin D levels in FEP and for the development of appropriate management strategies.

© 2013 Elsevier B.V. All rights reserved.
PMID: 24060571

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See also VitaminDWiki

• Search Psychosis in VitaminDWIki 217 items Dec 2017
• All items in Winter Blues/Depression and vitamin D 269 items

ADHD, Autism, Early Psychosis and Omega-3 – review Dec 2017

• Psychosis in dark skinned people 3.5 X higher if low level of vitamin D – May 2012
• Vitamin D3 associated with fewer psychotic episodes, D2 with more – July 2012
• Psychiatric disorders 4X more likely in teens if low vitamin D - Nov 2011
• Mental Illness and Vitamin D
• 99 percent of psychiatric population had less than 30 ng of vitamin D – June 2013
• Overview Schizophrenia and Vitamin D contains the following summary
  14 reasons to think that schizophrenia is associated with low vitamin D

1) 97% of patients with schizophrenia are vitamin D deficient
2) Schizophrenia varies with latitude (UVB) by 10X (controversy)
3) Schizophrenia is more common in those with dark skin (when away from the equator)
4) Schizophrenia is associated with low natal vitamin D
5) Schizophrenia has been increasing around the world when vitamin D has been decreasing (controversy)
6) Schizophrenia is associated with low birth rate, which is associated with low vitamin D
7) Schizophrenia is associated with Autism which is associated with low vitamin D
8) Schizophrenia Bulletin Editorial (Jan 2014) speculated that Vitamin D could be a major player
9) Schizophrenia 2X more likely if low vitamin D - meta-analysis
10) Schizophrenia increased 40 % for Spring births after Danes stopped vitamin D fortification
11) Schizophrenia is associated with season of birth
12) Schizophrenia is associated with poor Vitamin D Receptor genes
13) Schizophrenia risk is decreased if give Vitamin D after birth
14) Schizophrenia symptoms reduced when Vitamin D levels are restored

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See also web

Vitamin D status: Connection to first episode of psychosis?
Vitamin D Council review of this study, Oct 2013, Behind a $5 a month paywall
Nanogram/ml levels

	Whites	Blacks	Asians
Cases:	18	9.6	10
Controls:	27	14	16

• Vitamin D insufficiency in psychiatric inpatients.
  J Psychiatr Pract. 2013 Jul;19(4):296-300. doi: 10.1097/01.pra.0000432599.24761.c1.
  The mean vitamin D level on admission was 22.3 ng/mL, with a range of 4-79.2 ng/mL. The incidence of vitamin D insufficiency (defined as levels < 30 ng/mL) was 75%.
• Ethnic minority position and risk for psychotic disorders (in Netherlands)
  Curr Opin Psychiatry. 2013 Mar;26(2):166-71. doi: 10.1097/YCO.0b013e32835d9e43.
  A meta-analysis found that both first and second-generation migrants have on average a two-fold increase in risk for psychotic disorders.
  (That is, dark skinned people, which typically have lower vitamin D, were 2X more likely to have psychotic disorders)
• Vitamin D deficiency and psychotic features in mentally ill adolescents: a cross-sectional study.
  BMC Psychiatry. 2012 May 9;12:38. doi: 10.1186/1471-244X-12-38.
  The association for vitamin D deficiency and psychotic features was substantial (OR 3.5; 95% CI 1.4-8.9; p <0.009).
  Race was independently associated with vitamin D deficiency and independently associated with psychosis for those who were Asian or biracial vs. white (OR=3.8; 95% CI 1.1‒13.4; p<0.04).
• Review of the study in MedScape
  Previous research has shown that individuals with psychotic disorders often have vitamin D deficiency. However, this could be caused by long periods of hospitalization, use of anticonvulsant medications, or poor diet, note the investigators.
  69 adult inpatients (39% men; 56% white, 29% black, 14% Asian; mean age, 31 years
  14.6 ng vs 21.5 ng, Deficiency 36.2% vs 15.9%

They note 3 possible causes for the association:

1. During the often long prodromal phase, many patients with schizophrenia withdraw from normal activities, and this might result in a reduction in sunlight exposure.
2. Having low levels of vitamin D over a long period may be a risk factor for developing psychosis.
3. Because vitamin D is a negative acute-phase reactant, levels can decrease during an inflammatory response.
   Comment on MedScape: My clinical experience shows that "sick" patients require a lot more vit D3 supplements than usual and than healthier patients to maintain the same blood levels . It seems that the active phases of illness consume this vitamin in a fashion similar to how patients with colds can tolerate higher levels of vitamin C supplementation before they get loose stools when compared to their tolerated level when healthy.

• New research links vitamin D deficiency with serious mental disorders Dec 2013, review of study on this page
  Arctic hysteria.=“piblokto.” (Eskimos) = “cabin fever.”