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Pernicious anaemia presenting as catatonia without signs of anaemia or macrocytosis

  • S. Jauhar (a1), A. Blackett (a2), P. Srireddy (a3) and P. J. McKenna (a4)

Summary

Pernicious anaemia can present with psychiatric symptoms before haematological or neurological manifestations appear. We describe a young woman who presented with insidious onset catatonia without evidence of psychosis or depression. Blood count and mean cell volume were normal and neurological findings were equivocal. Low B12 levels and intrinsic factor antibodies were found only by chance when they were included in a battery of further investigations. B12 replacement was followed by prompt improvement. This case provides an argument for wider screening for B12 deficiency in certain individuals with psychiatric disorders.

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Copyright

COPYRIGHT: © Royal College of Psychiatrists, 2010 

Corresponding author

S. Jauhar, Hairmyres Hospital, East Kilbride, Lanarkshire, G75 8RG, UK. Email: sameerjauhar@yahoo.co.uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 Lishman, WA. Organic Psychiatry: The Psychological Consequences of Cerebral Disorder. Blackwell Science, 1998.
2 Berry, N, Sagar, R, Tripathi, BM. Catatonia and other psychiatric symptoms with vitamin B12 deficiency. Acta Psychiatr Scand 2003; 108: 156–9.
3 Mioshi, E, Dawson, K, Mitchell, J, Arnold, R, Hodges, JR. The Addenbrooke's Cognitive Examination Revised (ACE-R); a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006; 21: 1078–85.
4 Wilson, B, Cockburn, J, Baddeley, AD. Rivermead Behavioural Memory Test. Thames Valley Test Company, 1985.
5 Burgess, PW, Shallice, T. The Hayling and Brixton Tests. Thames Valley Test Company, 1997.
6 Goldberg, TE, Goldman, RS, Burdick, KE, Malhotra, AK, Lencz, T, Patel, RC, et al. Cognitive improvement after treatment with second-generation antipsychotic medications in first-episode schizophrenia: is it a practice effect? Arch Gen Psychiatry 2007; 64: 1115–22.
7 Eastley, R, Wilcock, GK, Bucks, RS. Vitamin B12 deficiency in dementia and cognitive impairment: the effects of treatment on neuropsychological function. Int J Geriatr Psychiatry 2000; 15: 226–33.
8 Vry, MS, Haerter, K, Kastrup, O, Gizewski, E, Frings, M, Maschke, M. Vitamin B12–deficiency causing isolated and partially reversible leukoencephalopathy. J Neurology 2005; 252: 980–2.
9 Lindenbaum, J, Healton, EB, Savage, DG, Brust, JC, Garrett, TJ, Podell, ER. Neuropsychiatric disorders caused by cobalamine deficiency in the absence of anemia or macrocytosis. NEJM 1988; 318: 1720–8.
10 Fink, M, Shorter, E, Taylor, MA. Catatonia is not schizophrenia: Kraepelin's error and the need to recognize catatonia as an independent syndrome in medical nomenclature. Schizophr Bull 2010; 36: 314–20.
  • Cited by 8

  • Access

Pernicious anaemia presenting as catatonia without signs of anaemia or macrocytosis

  • S. Jauhar (a1), A. Blackett (a2), P. Srireddy (a3) and P. J. McKenna (a4)

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  • Cited by 8

  • Access

Pernicious anaemia presenting as catatonia without signs of anaemia or macrocytosis

  • S. Jauhar (a1), A. Blackett (a2), P. Srireddy (a3) and P. J. McKenna (a4)
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