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 Table of Contents    
CASE REPORT
Year : 2011  |  Volume : 33  |  Issue : 2  |  Page : 203-204  

Obsessive compulsive disorder as early manifestation of b12 deficiency


1 Department of Family Medicine, General Practitioner, Urmia University of Medical Sciences, Urmia, Iran
2 Department of Internal Medicine, Section of Hematology/Medical Oncology, Urmia University of Medical Sciences, Emam Khomeini Hospital, Urmia, Iran

Date of Web Publication20-Jan-2012

Correspondence Address:
Nasim Valizadeh
Department of Internal Medicine, Section of Hematology/Medical Oncology, Urmia University of Medical Sciences, Emam Khomeini Hospital, Urmia
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7176.92051

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   Abstract 

B12 acts as a cofactor in synthesis of neurotransmitters such as serotonin and dopamine, thus B12 deficiency affects mood, emotions and sleeping and can lead to psychiatric disorders. Psychiatric manifestations of B12 deficiency are varied. They seldom precede anemia. We want to present a case of B12 deficiency which was presented with obsessive compulsive disorder.

Keywords: Anemia, B12 deficiency, obsessive compulsive disorder


How to cite this article:
Valizadeh M, Valizadeh N. Obsessive compulsive disorder as early manifestation of b12 deficiency. Indian J Psychol Med 2011;33:203-4

How to cite this URL:
Valizadeh M, Valizadeh N. Obsessive compulsive disorder as early manifestation of b12 deficiency. Indian J Psychol Med [serial online] 2011 [cited 2019 Dec 16];33:203-4. Available from: http://www.ijpm.info/text.asp?2011/33/2/203/92051


   Introduction Top


B12 deficiency has hematological and neuropsychiatric manifestations. Neuropsychiatric manifestations are included : p0 eripheral neuropathy, myeloneuropathy, cerebellar ataxia, optic atrophy, mood disorders, psychosis, personality changes, loss of memory, depression, dementia, confusion and more rarely reversible manic and schizoferniform status and obsessive compulsive disorder (OCD). [1],[2],[3],[4],[5],[6],[7],[8] Psychiatric manifestations of B12 deficiency seldom precede anemia. [6],[7],[8] We present a case of B12 deficiency in which OCD precedes anemia.


   Case Report Top


A 29-year-old female came with anxiety and history of OCD since 11 years ago. She had a history of menorrhagia. Drug history was positive for irregular consumption of ferrous sulfate, Inderal and Fluoxetine. History taking revealed anxiety, changes in mood and OCD. In physical examination she had only pallor. Neurological exam was normal. General blood chemistries including thyroid function tests, liver function tests, renal function tests, CBC diff, hemoglobin level and iron profile had been performed 5 months ago and all were in normal ranges [Table 1], but further investigations in recent visit showed mild anemia (Hb=11.8 g/dl, MCV=89 fl) and markedly diminished serum cobalamine level to <30 pg/ml and also iron deficiency with significant decreased ferritin level to 1.28 ng/ml [Table 2].
Table 1: Laboratory findings of first visit

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Table 2: Laboratory findings of the recent visit

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The association between B12 deficiency and iron deficiency in this case was our explanation to her normocytic anemia. Diagnosis of B12 deficiency with OCD manifestation and concurrent iron deficiency was made and parenteral B12 and oral iron replacement therapy initiated.


   Result Top


In this 29-year-old female, OCD was the early manifestation of B12 deficiency.


   Discussion Top


Although, it was rarely reported, but psychiatric and mood disorders may be the first manifestation of B12 deficiency and precede anemia. [6],[7],[8] We recommend checking serum B12 and folate level in any case with psychiatric disorder such as OCD, even in the absence of anemia and other hematologic manifestations of B12 and/or folate deficiencies. B12 replacement therapy can resolve symptoms of psychiatric disorders in patients with B12 deficiency.Literature review shows that patients with OCD have dysregulation in serotoninergic system and efficacy of serotonin reuptake inhibitors (SRIs) in the treatment of OCD was demonstrated. [9],[10],[11],[12] Neurotransmitters (dopamine, serotonin and melatonin) are necessary for a normal balanced mood, emotions and also sleeping. Folic acid and Vitamin B12 act as cofactors in synthesis of neurotransmitters such as serotonin and norepinephrine. [13] B12 deficiency affects level of neurotransmitters and leads to mooddisorders. [14]

Although it is rare but psychiatric manifestations of B12 deficiency may precede anemia as we saw in this case.



 
   References Top

1.Durand C, Mary S, Brazo P, Dollfus S. Psychiatric manifestations of vitamin B12 deficiency: A case report. Encephale 2003;29:560-5.  Back to cited text no. 1
    
2.El Otmani H, El Moutawakil B, Moutaouakil F, Gam I, Rafai MA, Slassi I. Postoperative dementia: Toxicity of nitrous oxide. Encephale 2007;33:95-7.  Back to cited text no. 2
    
3.Hutto BR. Folate and cobalamin in psychiatric illness. Compr Psychiatry 1997;38:305-14.  Back to cited text no. 3
    
4.Verbanck PM, Le Bon O. Changing psychiatric symptoms in a patient with vitamin B12 deficiency. J Clin Psychiatry 1991;52:182-3.  Back to cited text no. 4
    
5.Hector M, Burton JR. What are the psychiatric manifestations of vitamin B12 deficiency? J Am Geriatr Soc 1988;36:1105-12.  Back to cited text no. 5
    
6.Gomez-Bernal GJ, Bernal-Perez M. Vitamin B 12 deficiency manifested as mania: A case report. Prim Care Companion. J Clin Psychiatry 2007;9:238.  Back to cited text no. 6
    
7.Lindenbaum J, Healton EB, Savage DG, Brust JC, Garrett TJ, Podell ER, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988;318:1720-8.  Back to cited text no. 7
    
8.Evans DL, Edelsohn GA, Golden RN. Organic psychosis without anemia or spinal cord symptoms in patients with vitamin B12 deficiency. Am J Psychiatry 1983;140:218-21.  Back to cited text no. 8
    
9.Aouizerate B, Guehl D, Cuny E, Rougier A, Burbaud P, Tignol J, et al. Updated overview of the putative role of the serotoninergic system in obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2005;1:231-43.  Back to cited text no. 9
    
10.Barbarich N. Is there a common mechanism of serotonin dys regulation in anorexia nervosa and obsessive compulsive disorder? Eat Weight Disord 2002;7:221-31.  Back to cited text no. 10
    
11.Jarry JL, Vaccarino FJ. Eating disorder and obsessive-compulsive disorder: Neurochemical and phenomenological commonalities. J Psychiatry Neurosci 1996;21:36-48.  Back to cited text no. 11
    
12.Heiden A, de Zwaan M, Frey R, Presslich O, Kasper S. Paroxetine in a patient with obsessive-compulsive disorder, anorexia nervosa and schizotypal personality disorder. J0 Psychiatry Neurosci 1998;23:179-80.  Back to cited text no. 12
    
13.Hutto BR. Folate and cobalamin in psychiatric illness. Compr Psychiatry 1997;38:305-14.  Back to cited text no. 13
    
14.Deana R, Vincenti E, Deana AD. Levels of neurotransmitters in brain of vitamin B12 deficient rats. Int J Vitam Nutr Res 1977;47:119-22.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
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[Pubmed]



 

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