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Vitamin D status: Connection to first episode of psychosis?

Posted on: October 12, 2013   by  John Cannell, MD

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Psychosis is one of the scariest of medical conditions; it is a loss of touch with reality. Psychosis can manifest itself in many ways. Some people will hear voices or see things that are not there. Other people will have fixed false beliefs called delusions. Yet other people will have the sensation the radio or television is speaking to them directly, or the sensation of thoughts are being inserted or withdrawn against their will. Disorganized speech and grossly disorganized behavior can occur. Anything that demonstrates a loss of touch with reality is a psychosis.

Some people with psychosis will go on to develop schizophrenia. Schizophrenia is a brain disease characterized by a breakdown of thought processes and by a deficit of typical emotional responses. Common symptoms are delusions and disorganized thinking including auditory hallucinations, paranoia, bizarre delusions, disorganized speech, and it is accompanied by significant social or occupational dysfunction. About 1 in 200 people will develop schizophrenia in their lifetime.

Researchers in England recently studied the vitamin D levels of patients with their first episode of psychosis. Doctor Matthieu Crews led by senior author Doctor Fiona Gaughran studied 69 patients hospitalized for their first episode of psychosis.

Crews, M., et al., Vitamin D deficiency in first episode psychosis: A case–control study, Schizophr. Res. (2013).

They found somewhat stark differences between patients and matched controls. While they defined deficiency as lower than 10 ng/ml and insufficiency as between 10 and 20 ng/ml, the table below shows the actual levels.

Vitamin D levels in ng/ml
Whites (38) Blacks (19) Asians (9)
Cases: 18 9.6 10
Controls: 27 14 16

The difference in mean levels between White patients vs. White controls is stark, 18 vs. 27 ng/ml.  Usually in studies of vitamin D level differences in various diseases, the differences are a few ng/ml. Not here. The odds ratio of having a vitamin D level below 10 ng/ml was three times higher in the psychotic patients than in controls.

The authors concluded:

“We examined vitamin D levels in people at the first onset of psychotic illness and found them lower than those reported in the population with established psychotic illnesses and, lower than matched controls. Further work is needed to see whether this line of work may yield strategies to prevent or modify the course of the disease or improve longevity in the disorder.

These risks highlight the need for practical guidelines to help this group access appropriate and equitable care, preventing vitamin D deficiency from occurring, and how to manage it when it is detected or suspected.”

This paper is supportive of John McGrath’s theory that schizophrenia is caused by vitamin D deficiency. I understand John will be studying supplementation of 5,000 IU/day in patients with first episode psychosis in the near future. I suspect it may show a treatment effect, but the damage may already be done by the time of the first episode of psychosis.

The prognosis is so grim in psychosis, if I were treating patients with psychosis, I would use much higher amounts, up to 50,000 IU/day, realizing that a few patients would probably get hypercalcemia at that dose. It would be easy to measure calcium levels periodically and lessen the dose, much easier than missing a treatment effect because of inadequate dosage.

The reason why I’d use high amounts is because some scientists suspect that intracellular levels of activated vitamin D are dose dependent on serum 25(OH)D levels up to levels  around 200 ng/ml, which is what long-term treatment with 50,000 IU/day would generally obtain. However, I am only speculating and this has not been studied. Such doses are called pharmaceutical doses and those testing the activated vitamin D analogs in cancer chemotherapy have long used them.

When giving such an analog, hypercalcemia is expected in some patients, all that is needed is testing of serum calcium and a downward dose adjustment if needed. The same approach should be used when testing 50,000 IU/day of vitamin D3 in first episode psychosis. Reinhold Vieth first wrote about the need to test pharmacological doses of vitamin D3 back in 1999, in a classic must read paper free at the American Journal of Clinical Nutrition.

Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999 May;69(5):842-56. Review.

 

5 Responses to Vitamin D status: Connection to first episode of psychosis?

  1. Rita and Misty

    It would be interesting to look at the connection between vitamin D deficiency with respect to not only the conditions of psychosis and schizophrenia, but also epilepsy and bi-polar condition. Each of conditions may have episodes of delusion attached to them.

  2. Rita and Misty

    As someone who has suffered greatly with Premenstrual dysphoric disorder (PMDD) since age 11, and who has had the benefit of having this awful condition virtually disappear with 50,000 iu D3 daily during “hell week,” I wonder if the connection regarding D and brain conditions might have to do with GABA?

    I know that increasing serotonin levels will increase GABA levels.

    Vitamin D increases serotonin levels….

    Follow the dots….

  3. PeterVermont

    If taken with adequate vitamin K2, is hypercalcemia still a risk?

    What is status of the hypothesis outlined in “Vitamin D toxicity redefined: vitamin K and the molecular mechanism“? It speculated that vitamin D toxicity could possibly be avoided entirely with adequate co administration of vitamin K2.

  4. Rita and Misty

    (I do wonder if Einstein would have been Einstein if he had an optimal 25(OH)D level…or if Joan of Arc would have been Joan of Arc…Just musing at 10:35 p.m. ET)

  5. Rita and Misty

    The attached article doesn’t touch on D, but it is still intriguing in terms of schizophrenia and psychosis;

    http://news.yale.edu/2013/10/31/left-handed-people-more-likely-have-psychotic-disorders-such-schizophrenia-yale-study

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