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Vitamin D deficiency in psychiatric in-patients and treatment with daily supplements of calcium and ergocalciferol

  • Eleanor Tiangga (a1), Asha Gowda (a1) and John A. Dent (a1)
Abstract
Aims and Method

This study examines the prevalence of vitamin D deficiency in a group of male psychiatric in-patients and follows 16 of them prospectively during treatment with calcium and ergocalciferol tablets.

Results

Of 17 male patients, 15 had vitamin D deficiency and two had borderline deficiency. Vitamin D deficiency was associated with Black and minority ethnic background. Improvement in vitamin D status was observed following replacement therapy.

Clinical Implications

Vitamin D deficiency may be widespread in the psychiatric population particularly in Black and minority ethnic but also in White European in-patients. Vitamin D level should be routinely monitored in psychiatric in-patients. for those with vitamin D deficiency, replacement therapy can be commenced with calcium and ergocalciferol tablets (containing 10 μg of ergocalciferol), which is safe and well tolerated. All psychiatric in-patients should have adequate exposure to sunlight and attention to diet to ensure that they receive their recommended daily allowance of vitamins and minerals.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Anonymous (2006a) Primary vitamin D deficiency in children. Drug and Therapeutics Bulletin, 44, 612.
Anonymous (2006b) Primary vitamin D deficiency in adults. Drug and Therapeutics Bulletin, 44, 2529.
Grant, W. B. (2006) Epidemiology of disease risks in relation to vitamin D insufficiency. Progress in Biophysics and Molecular Biology, 92, 6579.
Handoko, H.Y., Nancarrow, D. J., Mowry, B. J., et al (2006) Polymorphisms in the vitamin D receptor and their associations with risk of schizophrenia and selected anthropometric measures. American Journal of Human Biology, 18, 415417.
Hirani, V. & Primatesta, P. (2005) Vitamin D concentrations among people aged 65 years and over living in private households and institutions in England: population survey. Age and Ageing, 34, 485491.
Howard, D. A., Waygood, S. D. & Desmond, S. L. (2006) Vitamin D and chronic mental illness. Medical Journal of Australia, 184, 47.
McGrath, J., Saari, K., Hakko, H., et al (2004) Vitamin D supplementation in the first year of life and risk of schizophrenia: a Finnish birth cohort study. Schizophrenia Research, 67, 237245.
Ustianowski, A., Shaffer, R., Collin, S., et al (2005) Prevalence and associations of vitamin D deficiency in foreign-born persons with tuberculosis in London. Journal of Infection, 50, 432437.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Vitamin D deficiency in psychiatric in-patients and treatment with daily supplements of calcium and ergocalciferol

  • Eleanor Tiangga (a1), Asha Gowda (a1) and John A. Dent (a1)
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eLetters

Vitamin D deficiency and mental illness

Vishelle Kamath, Specialist Registrar in Old Age Pscyhiatry
27 October 2008

Dear Sir,

Tiangga et al. have concluded that male psychiatric inpatients appearto be at risk of Vitamin D deficiency. We would like to draw your attention to two further groups of mental health service users namely women and the elderly who are vulnerable to the same risk with adverse consequences.

A cross section of older adults selected from a longitudinal study ofmemory and ageing suggested that Vitamin D deficiency was associated with low mood and impairment in measures of cognitive performance (1). It is worth noting that the prevalence of Vitamin D deficiency in all adults in the UK is about 14.5% and rises to more than 30% in those over 65 years ofage. (3) An integrative review on Vitamin D and mood disorder in women, showed the results in four out of six studies demonstrated significant association between low 25 Hydroxyvitamin D levels and higher levels of mood disorder which included premenstrual syndrome, seasonal affective disorder, non specific mood disorder and major depressive disorder (2).

The high prevalence rate of Vitamin D deficiency, the avoidable complications and positive outcomes of treatment suggest that Vitamin D deficiency should be addressed through public health measures. Effective preventative measures should be considered along with exploring detection and treatment.

A simple preventative measure in the UK is the exposure of the body to sub thermal doses of sunlight for 15 minutes twice or three times weekly from April to September, which should result in sufficient skin synthesis of Vitamin D (3). This simple measure can be implemented in mental heath units at no additional cost or harm to patients.

References:

1. Consuelo H. Wilkins, M.D., Yvette I. Sheline, M.D., Catherine M. Roe, Ph.D., Stanley J. Birge, M.D., and John C. Morris, M.D., Vitamin D Deficiency Is Associated With Low Mood and Worse Cognitive Performance in Older Adults; American Journal of Geriatric Psychiatry 14:1032-1040, December 2006

2. Murphy PK, Wagner CL; Vitamin D and Mood Disorders Among Women: AnIntegrative Review; Journal of Midwifery & Women's Health, Volume 53, Issue 5, Pages 440 - 6.

3. Primary vitamin D deficiency in adults; Drug and Therapeutics Bulletin 2006; 44:25-29
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Conflict of interest: None Declared

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Vitamin D deficiency in psychiatric inpatients

Rayin N Kulambil Padinjakara, Specialist Registrar, Diabetes and Endocrinology
09 October 2008

It is not surprising that Eleanor Tiangga et al found lower levels ofvitamin D in long stay psychiatric patients who are at high risk of developing vitamin D deficiency.

Although 25-hydroxy vitamin D measurement is the gold standard for diagnosing the problem, it is done in specialist laboratories and often the results will take weeks to come back. On a wider scale it useful to dobasic lab tests like serum calcium, phosphate and parathyroid hormone levels. Raised parathyroid hormone levels along with low normal calcium level are the most common metabolic abnormality in vitamin D deficiency. These tests are cheaper and easily done in most hospitals with results coming back within a week.

If the above mentioned metabolic pattern is found patients could be started on calcium and vitamin D tablets after sending a blood sample for vitamin D levels.

A good source of vitamin D for preventive purposes is cod liver oil. Most of the commercially available cod liver oil capsules provide 100% RDA(recommended daily allowance) of vitamin D and vitamin A with added benefit of omega 3 fatty acids!

Reference

ELEANOR TIANGGA, ASHA GOWDA, JOHN A. DENT (2008) Vitamin D deficiencyin psychiatric in-patients and treatment with daily supplements of calciumand ergocalciferol. Psychiatric bulletin, 32, 390-393

Declaration of interest - None

Authors

Fabida Noushad, CT3 General Adult Psychiatry, Coventry and Warwickshire Partnership NHS Trust

RN Kulambil Padinjakara, Specialist Registrar, Diabetes and Endocrinology, University Hospitals Coventry and Warwickshire NHS Trust, Walsgrave, Coventry, CV2 2DX, email: rayin.padinjakara@uhcw.nhs.uk
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Conflict of interest: None Declared

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