Nutrient deficiencies in first-episode psychosis

Meta-analyses evaluating nutrient levels in patients with long-term schizophrenia have identified deficiencies in folate, vitamin B12, vitamin C, vitamin E and vitamin D

Whether these deficiencies precede psychosis or result from disease progression and medication side-effects is not known.

First-episode psychosis is considered to be a critical period of disease, when inflammation and oxidative stress are at a high point, the process of neuroprogression is most active, and antipsychotic medications that cause metabolic dysfunction are initiated.

Knowledge of nutrient deficiencies in first-episode psychosis could guide clinical interventions that might attenuate neuroprogression and metabolic risk.

Researchers aimed to quantify the presence and severity of nutrient deficiencies in first-episode psychosis with a meta-analysis of all vitamins and minerals studied in this population to date (through July of 2017).

The analysis included 28 articles involving 24 unique study samples and 2612 participants (1221 with first-episode psychosis and 1391 controls).

The studies reported differences in blood levels of six vitamins (A, B12, C, D, E and folate) and 10 minerals (zinc, magnesium, sodium, potassium, calcium, copper, chromium, iron, manganese, and selenium).

Studies were conducted in 12 countries around the globe.

Meta-analysis found significant reductions in folate, vitamin D, and vitamin C in people with first-episode psychosis compared with controls.

No significant differences were detected for other vitamins. The difference in vitamin D levels between first-episode psychosis and controls was the most pronounced of all nutrients, with a fail-safe N of 265, indicating that 265 additional studies with null findings would be needed to make the observed difference nonsignificant.

Also, lower vitamin D levels correlated with more severe psychotic symptoms.

Lower blood levels of folate in first-episode psychosis were also significant, with a fail-safe N of 71.

Of interest, one study found that the differences in folate levels did not result from dietary differences but rather from genetic differences in folate metabolism. Large deficits of vitamin C were reported in first-episode psychosis, but only from two studies with small sample sizes.

This meta-analysis is the first to show that nutrient deficiencies not only exist in long-standing psychosis but also exist at the onset of first-episode psychosis.

Clinicians may find that evaluation and treatment of nutrient deficiencies at the onset of psychosis could improve nutritional status and attenuate disease progression.