Vitamin Deficiencies and Psychiatric Illnesses

Deficiencies of vitamins are associated with psychiatric illnesses either by being the primary cause or an exacerbating factor. Psychiatric symptoms could also lead to poor nutrition. Vitamin deficiencies may play a role in compromising patient recovery.

Vitamins are organic substances essential for several enzymatic functions.

There are 13 known vitamins which are either fat soluble (4 vitamins i.e. KEDA) or water soluble (9 vitamins i.e. C, & the B group).

Regarding brain function, B vitamins are essential in the maintenance of myelin, neuro-transmitter production, and methylation cycle. Fat-soluble vitamins are necessary in inflammatory regulation, regeneration of antioxidants and genetic modification.

Few studies of vitamin deficiencies have been carried out in Sub-Saharan Africa. Below is an overview of vitamins and their relation to neuropsychiatric disorders with the focus on Africa.

Vitamin B1 deficiency

Thiamine (Vitamin B1) is critical for glucose metabolism. It is a cofactor of α-ketoglutarate dehydrogenase and pyruvate dehydrogenase enzymes both within the citric acid cycle and transketolase enzyme in the pentose phosphate pathway. Severe B1 deficiency which may result from chronic alcoholism, diabetes or malnutrition is usually associated with Wernicke’s encephalopathy (WE). WE clinically characterised by confusion, ataxia, and nystagmus, is an acute neuropsychiatric disorder which arises as a result of inadequate supply of thiamine to the brain. Confusion and disorientation stem from the brain’s inability to oxidize glucose for energy because B1 is a crucial cofactor in glycolysis and the citric acid cycle. Deficiency leads to an increase in free oxygen radicals, cytokines, and alteration of the blood–b...

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...nt enzymes. Neuronal mem-branes are protected from oxidation by vitamin E hence reducing inflammation of the brain. Tocotrienols are understood to mediate disease by modifying transcription factors in the brain, for instance glutathione reductase, and superoxide dismutase (35). Depression has been associated with low plasma vitamin E levels, although other factors excluding dietary intake have been considered (36).

Ataxia with vitamin E deficiency (AVED) is a rare autosomal recessive neurodegenerative disease that occurs in North Africa (37). Its early identification is essential in order to initiate therapeutic and prophylactic vitamin E supplementation before irreversible damage develops.

In Uganda, 63 (30.3%) of the 208 cases studied showed vitamin E deficiency. Among these, four of five patients with cerebrovascular accidents had vitamin E deficiency (38).