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Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report

Vitamin B12 is one of the essential vitamins affecting various systems of the body. Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old, male adolescent who presented with mixed moo...

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Autores principales: Tufan, Ali Evren, Bilici, Rabia, Usta, Genco, Erdoğan, Ayten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404901/
https://www.ncbi.nlm.nih.gov/pubmed/22726236
http://dx.doi.org/10.1186/1753-2000-6-25
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author Tufan, Ali Evren
Bilici, Rabia
Usta, Genco
Erdoğan, Ayten
author_facet Tufan, Ali Evren
Bilici, Rabia
Usta, Genco
Erdoğan, Ayten
author_sort Tufan, Ali Evren
collection PubMed
description Vitamin B12 is one of the essential vitamins affecting various systems of the body. Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old, male adolescent who presented with mixed mood disorder symptoms with psychotic features. Chief complaints were “irritability, regressive behavior, apathy, crying and truancy” which lasted for a year. Premorbid personality was unremarkable with no substance use/exposure or infections. No stressors were present. The patient was not vegetarian. Past medical history and family history was normal. Neurological examination revealed glossitis, ataxia, rigidity in both shoulders, cog-wheel rigidity in the left elbow, bilateral problems of coordination in cerebellar examination, reduced swinging of the arms and masked face. Romberg’s sign was present. Laboratory evaluations were normal. Endoscopy and biopsy revealed atrophy of the gastric mucosa with Helicobacter Pylori colonization. Schilling test was suggestive of malabsorbtion. He was diagnosed with Mood disorder with Mixed, Psychotic Features due to Vitamin B12 Deficiency and risperidone 0.5 mg/day and intramuscular vitamin B12 500 mcg/day were started along with referral for treatment of Helicobacter pylori. A visit on the second week revealed no psychotic features. Romberg’s sign was negative and cerebellar tests were normal. Extrapyramidal symptoms were reduced while Vitamin B12 levels were elevated. Risperidone was stopped and parenteral Vitamin B12 treatment was continued with monthly injections for 3 months. Follow-up endoscopy and biopsy at the first month demonstrated eradication of H. pylori. He was followed monthly for another 6 months and psychiatric symptoms did not recur at the time of last evaluation. Despite limitations, this case may underline the observation that mood disorders with psychotic features especially with accompanying extrapyramidal symptoms lacking a clear etiology may be rare manifestation of vitamin B12 and/or folate deficiency in children and adolescents and be potentially amenable to treatment.
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spelling pubmed-34049012012-07-26 Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report Tufan, Ali Evren Bilici, Rabia Usta, Genco Erdoğan, Ayten Child Adolesc Psychiatry Ment Health Case Report Vitamin B12 is one of the essential vitamins affecting various systems of the body. Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old, male adolescent who presented with mixed mood disorder symptoms with psychotic features. Chief complaints were “irritability, regressive behavior, apathy, crying and truancy” which lasted for a year. Premorbid personality was unremarkable with no substance use/exposure or infections. No stressors were present. The patient was not vegetarian. Past medical history and family history was normal. Neurological examination revealed glossitis, ataxia, rigidity in both shoulders, cog-wheel rigidity in the left elbow, bilateral problems of coordination in cerebellar examination, reduced swinging of the arms and masked face. Romberg’s sign was present. Laboratory evaluations were normal. Endoscopy and biopsy revealed atrophy of the gastric mucosa with Helicobacter Pylori colonization. Schilling test was suggestive of malabsorbtion. He was diagnosed with Mood disorder with Mixed, Psychotic Features due to Vitamin B12 Deficiency and risperidone 0.5 mg/day and intramuscular vitamin B12 500 mcg/day were started along with referral for treatment of Helicobacter pylori. A visit on the second week revealed no psychotic features. Romberg’s sign was negative and cerebellar tests were normal. Extrapyramidal symptoms were reduced while Vitamin B12 levels were elevated. Risperidone was stopped and parenteral Vitamin B12 treatment was continued with monthly injections for 3 months. Follow-up endoscopy and biopsy at the first month demonstrated eradication of H. pylori. He was followed monthly for another 6 months and psychiatric symptoms did not recur at the time of last evaluation. Despite limitations, this case may underline the observation that mood disorders with psychotic features especially with accompanying extrapyramidal symptoms lacking a clear etiology may be rare manifestation of vitamin B12 and/or folate deficiency in children and adolescents and be potentially amenable to treatment. BioMed Central 2012-06-22 /pmc/articles/PMC3404901/ /pubmed/22726236 http://dx.doi.org/10.1186/1753-2000-6-25 Text en Copyright ©2012 Tufan et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Tufan, Ali Evren
Bilici, Rabia
Usta, Genco
Erdoğan, Ayten
Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report
title Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report
title_full Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report
title_fullStr Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report
title_full_unstemmed Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report
title_short Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report
title_sort mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404901/
https://www.ncbi.nlm.nih.gov/pubmed/22726236
http://dx.doi.org/10.1186/1753-2000-6-25
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