Authors: Atti Anna Rita, Scaramelli Anna Rosa, Magro Margherita, Parmigiani Cristiano, De Ronchi Diana.
Vitamin deficiencies are not very common in western high-income countries. However, psychiatric patients, especially those affected by Schizophrenia, frequently do not follow a healthy lifestyle. This can cause deficiencies.
We present the case of a 35-year old woman suffering from treatment-resistant disorganized Schizophrenia. The clinical picture, initially identified as a possible resurgence of the underlying pathology, was further complicated, leading clinicians to suspect first Neuroleptic Malignant Syndrome, and subsequently encephalomyelitis. Improvement of the clinical picture through deeper investigation highlighted a condition of sub-acute myelin degeneration on a dysmetabolic-deficiency basis; thus modifying the initial diagnosis from psychotic decompensation to the more correct diagnosis of neuro-psychiatric symptomatology due to lack of vitamin B-12.
In our case, vitamin deficiency mostly gave rise to neuropsychiatric symptoms, such as altered state of consciousness, agitation and accentuation of somatic delusions. These symptoms exacerbated the severe food restrictions in the patient, which worsened the deficiency and psychopathological situation. Vitamin deficits often remain silent for a long time, progressing in pathologies that are generally reversible but which, if not caught in time, can face further complications, making it difficult to trace their origin. It is therefore essential, in psychotic patients, to constantly investigate eating habits, and also to remember not to exclude a constant blood-chemical monitoring of the parameters that account for the nutritional status of the patient.
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