Neuropsychiatric Consequences of Vitamin Deficiencies: A Critical Review

Consultation-liaison (C-L) clinicians frequently direct the workup and treatment of patients with psychiatric symptoms and comorbid medical problems in the general hospital setting and outpatient clinics. Both critical and chronic illness intersect with socioeconomic consequences of mental illness in a way that may cause and exacerbate nutritional deficiencies. These deficiencies are likely under recognized and may play a role in various neuropsychiatric presentations.

There is a lack of consensus in the literature, and practice patterns vary widely, regarding which vitamin levels should be included in a general psychiatric workup. Furthermore, there is lack of guidance on when to expand the workup to look for rarer vitamin deficiencies, which vitamins to supplement empirically, how often to monitor, and specific dosing recommendations. These frequent clinical dilemmas can present themselves on a daily basis for the C-L clinician. Aligning clinical practice with the available literature is an important area of practice improvement for the C-L clinician.

This workshop will focus on five major vitamins – thiamine, folic acid, vitamin B12, vitamin D, and vitamin C. This workshop will briefly cover the basic science of metabolism and factors that influence these vitamins’ absorption; epidemiology and demographic risk factors for their deficiencies; neuropsychiatric presentations and consequences; and finally, treatment and monitoring of these vitamin deficiencies.

This workshop will present a timely review of the literature in order to convince the audience that vitamin deficiencies and replacement strategies should be considered an area of expertise for the C-L clinician. This presentation aims to empower the C-L clinician to place neuropsychiatric presentations and management of vitamin deficiencies firmly within his or her scope of practice.

Dr. Benjamin Cooley will review the evidence base regarding thiamine, including examining empiric replacement, routes of supplemental administration, and the neuropsychiatric consequences of thiamine deficiency.

Dr. Shariff Tanious will review the literature on vitamin B12, screening guidelines, replacement in specific patient populations, and its relationship to depression and neurocognitive disorders.

Dr. Emily Holmes will review the literature surrounding folic acid metabolism, deficiency, and supplementation in depression, pregnancy, and with the use of various psychotropic medications.

Dr. Caitlin Adams will discuss Vitamin D deficiency, guidelines on monitoring and replacement in psychiatric and medical patients, the evolving understanding of the relationships between Vitamin D and depression, as well as Vitamin D and delirium.

Dr. Bryce Wininger will summarize the literature on Vitamin C absorption and metabolism, populations most at risk for deficiency, and the neuropsychiatric consequences and physical signs of Vitamin C deficiency.

Conclusions: After attending this session attendees will feel empowered and knowledgable about the C-L clinician's role in the identification and treatment of vitamin deficiencies and their neuropsychiatric sequelae.