Posted by Phillipa on July 23, 2013, at 20:48:49
Medscape Medical News > Psychiatry
Vitamin D Insufficiency Highly Prevalent in Psychiatric Patients
Nancy A. Melville
Jul 22, 2013
Up to 75% of psychiatric inpatients have vitamin D insufficiency. However, this is more likely an effect of the chronic mental illness itself, rather than a cause, new research suggests.
The retrospective chart review of 544 patients admitted to the psychiatric ward of a community hospital in Illinois between December 2010 and June 2011 showed mean vitamin D levels among patients to be 22.3 ng/mL, with a range of 4 to 79.2 ng/mL.
Among the patients, 75% had vitamin D levels lower than 30 ng/mL, generally considered by groups, including the American College of Physicians, to represent insufficiency.
"Our results are consistent with prior studies and suggest that vitamin D insufficiency is highly prevalent in inpatient psychiatric populations and exceeds that in the general population," the authors concluded.
The study is published in the July issue of Journal of Psychiatric Practice.
Potential Causative Role?
The researchers controlled for variables including age, sex, month of admission, length of stay in the ward, medication usage, and Global Assessment of Functioning scale score at admission and found no correlation with vitamin D insufficiency.
Instead, the insufficiency may be the result of more general aspects of chronic mental illness, said Melanie Rylander, MD, lead author of the study.
"The fact that vitamin D deficiency is not specific to any one diagnosis makes its role in the pathogenesis of mental illness difficult to qualify," said Dr. Rylander, of the University of Colorado School of Medicine, in Denver.
"More likely, it is a consequence of chronic mental illness rather than a cause and relates to poor nutrition and inadequate sun exposure in this population."
The authors do not rule out the possibility of vitamin D insufficiency as a causative factor altogether, however, speculating on its role in the underlying pathogenesis of mental illness.
"Vitamin D insufficiency may be a causative factor in the pathogenesis of mental illness through interactions that affect cellular mechanisms, which eventually diverge into different clinically observed phenotypes," they write.
Either way, such insufficiencies should be addressed, yet the researchers also found that as many as 63% of patients with insufficient vitamin D levels were not treated with supplementation.
Is Supplementation Valuable?
The utility of supplementation in preventing or treating psychiatric conditions has not been proven, and one recent study showed no effect of supplementation on depressive symptoms or antidepressant use (Am J Epidemiol 2012;176:1-13).
Still, patients whose levels are insufficient or deficient should receive supplementation for the same reasons any other person with insufficiency should, Dr. Rylander said.
"Although some patients will report subjective improvement in symptoms such as fatigue, replacing inadequate vitamin D stores is more important for overall bone health than mental health based on the evidence at this point," she told Medscape Medical News.
The high percentage of psychiatric patients whose insufficiency went unaddressed in the study further underscores the need to increase awareness of potential deficiencies among patients with mental illness, the authors say.
"Given the potential role of this deficiency in the etiology of commonly treated psychiatric conditions as well as its role in nonpsychiatric conditions, identifying barriers to adequate replacement and addressing these will be important to the overall health of psychiatric patients," they write.
Need for Screening
Information from Industry
Commenting on the findings for Medscape Medical News, Paul Summergrad, MD, professor of medicine at Tufts University School of Medicine and psychiatrist-in-chief at Tufts Medical Center, in Boston, Massachusetts, said that the study adds to mounting evidence of an increased risk for vitamin D insufficiency among inpatients and not just those in psychiatric wards.
"This study seems to confirm previous findings, and we know there have been similar findings with nursing home patients who have some overlap with psychiatric inpatients, showing that vitamin D insufficiency appears to be a real problem for these patients," said Dr. Summergrad, who is the president-elect of the American Psychiatric Association.
He agreed that screening for vitamin D deficiency should be a standard part of psychiatric patient evaluation.
"Physicians who work in those units should make sure vitamin D screening and evaluation is part of routine evaluation of patients, not necessarily because it may be causative of psychiatric symptoms but because there are a lot of conditions that are associated with vitamin D deficiency osteoporosis, diabetes, and some other medical problems that are also relatively common in patients with psychiatric illnesses."
The authors and Dr. Summergrad report no relevant financial relationships.
J Psychiatr Pract. 2013;19:296300. Abstract