Nancy A. Melville

April 07, 2015

COLORADO SPRINGS, Colorado — With ever-increasing evidence of the role of vitamin D in mental health issues, a new study shows that low vitamin D levels in first-onset psychosis correlate with function and mood 12 months later.

"Low vitamin D is commonly found in people with psychosis, but it is unclear whether this is a result of psychosis, a predisposing factor, or relating to common risk factors," first author Fiona Gaughran, MD, of the National Psychosis Service, South London and Maudsley NHS Foundation Trust, United Kingdom, told Medscape Medical News.

"Clinical trials are needed to determine whether screening and prescribing supplemental vitamin D is indicated in psychosis," she added.

The findings were presented here at the 15th International Congress on Schizophrenia Research (ICOSR).

High Rate of Deficiency

Vitamin D deficiency occurring at various stages of development, including in utero, is linked to psychosis, a fact that prompted the investigators to examine the role of vitamin D in the early stages of the psychosis.

For the study, the researchers evaluated vitamin D levels in 166 patients (64% male) at first onset of psychosis and again 12 months later. Measurements were also collected from a separate group of 324 community patients who were known to have had psychosis for a period of approximately 15 years.

After adjusting for age, sex, ethnicity, and the season of sampling, patients with a first onset of psychosis were found to have a mean vitamin D level of just 13.64 ng/ml, significantly lower than the level of 20 ng/ml that is considered sufficient.

Only 18.7% of patients had vitamin D levels that were sufficient, or higher than 20 ng/ml, whereas 39.2% had levels considered insufficient, between 10 and 20 ng/ml, and 42.2% had levels considered deficient, at less than 10 ng/ml.

Low levels of vitamin D at presentation correlated significantly with disease signs and symptoms 12 months after presentation, including lower overall Global Assessment of Function scores (P = .02), poorer function (P = .05), and higher scores on the Calgary Depression Scale for Schizophrenia (P = .01).

Correlations were also seen between lower vitamin D levels at 12 months and Positive and Negative Syndrome Scale (PANSS) scores (P = .03) and quality-of-life scores (P = .02).

Among the 324 patients with psychosis (59% male), mean vitamin D levels were even lower, at 12.38 ng/ml. Only 13.9% of patients had sufficient vitamin D levels, and 48.8% were deficient.

Neuroprotective?

There was no association between vitamin D levels and duration of illness or function or PANSS scores. However, those who were deficient had lower quality-of-life scores and higher levels of depression on the Montgomery–Åsberg Depression Rating Scale (P = .02).

Low vitamin D levels in those with established psychosis were negatively correlated with an array of other health issues, including high body mass index (P = .03), high triglyceride levels (P = .001), high total cholesterol levels (P = .03), obesity (P = .03), and hypertension (P = .03).

In addition, vitamin D levels were lower among patients who had lower levels of exercise (P = .002) and who spent less time outdoors (P = .041).

Dr Gaughran emphasized the preliminary nature of the findings, and said that even with the mounting evidence of low vitamin D levels in psychosis, any benefits of supplementation are still unknown.

"People are thinking about vitamin D more now in many health areas, but the evidence for supplementation is just not there yet, even for physical health benefits," she said.

A large problem may be that, as described in an article published last month in JAMA, "clinical enthusiasm for supplemental vitamin D has outpaced available evidence on its effectiveness," Dr Gaughran said.

"[Supplementation] threatens to jeopardize the ability of researchers to conduct randomized trials in 'usual-risk' populations. [The authors'] advice was that, while awaiting the outcome of large trials, clinicians should 'avoid overscreening and overprescribing supplemental vitamin D,' " she added.

However, the researchers note that "the idea of vitamin D as potentially neuroprotective in psychosis deserves exploration."

Stark Reminder

The findings underscore the important role that vitamin D appears to play in psychosis, particularly in people at high risk for low vitamin D, such as those with dark skin, said John J. McGrath, MD, PhD, of the University of Queensland's Brain Institute, in Australia, who has published extensive research on vitamin D and schizophrenia.

"The [new] study is a stark reminder of how many patients with psychosis have low vitamin D," he told Medscape Medical News. "Especially in London, where many of the patients with psychosis have dark skin, low vitamin D is very common."

Although the findings likely reflect the fact that people with psychosis are less likely to engage in outdoor activity or to use vitamin D supplements, supplementation should be explored as a means of helping with the recovery from psychosis, he noted.

"Randomized clinical trials that have used vitamin D supplement in those with Parkinson's disease suggest that optimizing vitamin D concentration can delay progress of the disorder."

"Even if there is no impact on the symptoms of psychosis, it should help bone health and may also help comorbid physical disorders," Dr McGrath added.

"Our [psychiatric] patients have poor nutrition and poor physical health ― optimizing vitamin D levels should be a small part of a wider management program."

Dr Vaughan has received honoraria, been an advisor to, and/or has received educational grants from BMS, Roche, Lundbeck, and Sunovion and has family professional links to GSK and Lilly. Dr McGrath has disclosed no relevant financial relationships.

15th International Congress on Schizophrenia Research (ICOSR). Abstract 2118519. Presented March 31, 2015.

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