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

Created October 2013

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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

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

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.
Tags: Depression