Vitamin B12, folic acid, homocysteine and vitamin D levels in children and adolescents with obsessive compulsive disorder
Introduction
Obsessive compulsive disorder (OCD) is a psychiatric disorder characterized by obsessions (all kinds of images and impulses that are involuntary and persistent) and compulsions (repetitive involuntary behaviours that are performed to clear the mind of the obsessive thoughts and to eliminate the stress caused by them) (American Psychiatry Association, 2013). Epidemiological studies have demonstrated the prevalence of OCD in children and adolescents as 0.25–4% (Douglass et al., 1995; Flament, 1989; Heyman et al., 2001; Jaisoorya et al., 2015; Zohar et al., 1992). Adolescents with OCD have greater psychological distress and poorer academic performance together with higher rates of suicidal thoughts, suicide attempts, attention deficit and hyperactivity, sexual abuse and tobacco use (Jaisoorya et al., 2015). OCD is a complex psychiatric disorder that may occur due to genetics (Pauls, 2010), alterations in frontostriatal connections (Pauls et al., 2014), psychosocial experiences, perinatal injuries, toxic pathogens, stress and traumatic events and environmental factors like infections, particularly streptococcal infections (Grisham et al., 2008).
Vitamin B12, folic acid and homocysteine levels were shown to be associated with certain neuropsychiatric disorders and vitamin B12, folate deficiency and high levels of homocysteine were shown to have an impact on brain functions and cause non-specific psychiatric symptoms. Many studies found high levels of homocysteine, low levels of vitamin B12 and/ or folic acid in patients with schizophrenia (Haidemenos et al., 2007; Kim and Moon 2011; Mabrouk et al., 2011; Muntjewerff et al., 2006, Zhang et al., 2016), autism (Al-Farsi et al., 2013, Ali et al., 2011, Puig-Alcaraz et al., 2015, Tu et al., 2013, Zhang et al., 2016) and depression (Tiemeier et al., 2002; Tolmunen et al., 2004). In a study involving children and adolescents high levels of homocysteine were shown to be associated with schizophrenia and mood disorders (Kevere et al., 2012). In a few studies on adult patients with OCD, there is some evidence of increased homocysteine, deficient levels of folic acid and vitamin B12 in adult patients with OCD (Atmaca et al., 2005, Türksoy et al., 2014). Also cases of OCD that are due to a vitamin B12 deficiency have been reported (Sharma and Biswas, 2012, Valizadeh and Valizadeh, 2011). Circulating levels of homocysteine are accepted as a sensitive marker of folic acid and vitamin B12 (Folstein et al., 2007; Klee, 2000; Nilsson et al., 1999).
Vitamin D is another vitamin that has been investigated in the aetiology of psychiatric disorders. Vitamin D deficiency has been suggested to play an important role in the aetiology of schizophrenia and autism (Crews et al., 2013, Feng et al., 2016, McGrath et al., 2010; Saad et al., 2015; Valipour et al., 2014; Wang et al., 2016). Vitamin D deficiency can also contribute to development of depression and anxiety disorders (Anglin et al., 2013, Berk et al., 2007, Bertone-Johnson, 2009; Bicikova et al., 2015; Milaneschi et al., 2014). In the last few years, many reports demonstrating an important role for vitamin D in brain development and functions and aetiopathogenesis of neuropsychiatric disorders have been published (Eyles et al., 2013; Harms et al., 2011; McCann and Ames, 2008).
To the best of our knowledge the role of one carbon mechanism and vitamin D deficiency in children and adolescents with OCD has not yet been investigated. For this reason we aimed to investigate serum vitamin B12, folic acid homocysteine and vitamin D levels in children and adolescents in this study.
Section snippets
Materials and methods
All subjects were patients who attended the outpatient clinic for children and adolescent psychiatry at Ordu University Research and Training Hospital. Participants in the patient group were diagnosed according to DSM V criteria. Healthy control subjects were chosen from patients with minor issues that were admitted to the outpatient clinic for consultancy. All participants completed a sociodemographic form, Yale-Brown Obsessive Compulsive scale, KOVAKS depression scale, STAI-1 and STAI-2
Results
This study involves 52 OCD patients and 30 healthy controls. Fifty percent of patient group were boys (n=26) and 50% were girls (n=26). The mean age was 14.7±2.3 SD years. Fifty-three percent of the control group were girls (n=16) and 46.7% were boys (n=14). The mean age of the control group was 14.2±2.6 years (Table 1). None of the subjects were taking nutritional support like any medication or neuro-nutraceuticals.
There was no significant difference between patient and control groups in terms
Discussion
In this study the OCD group were found to have higher points on anxiety and depression scales. Obsessions in OCD patients lead to nearly constant fear, repulsion, anxiety and the need for repetition. The result is that OCD commonly occurs with other psychiatric disorders. It is proposed that 80% of OCD children have another axis I disorder (Friedlander and Desrocher, 2006; Pinto et al., 2006). Of these the most common appear to be other anxiety disorders at rates of 50% and depressive disorders
Conclusion
This study has demonstrated that there is a significant decrease in vitamin B12 and vitamin D and a significant increase in homocysteine in children and adolescents with OCD. Vitamin D deficiency may be a risk factor for development of OCD. Clinicians should be vigilant about one carbon metabolism and vitamin D levels in patients with OCD. The role of one carbon metabolism and vitamin D in the development of OCD symptoms should be researched in more advanced studies and limitations should be
Conflict of interest
The authors declare no conflict of interest. The authors declare that this study has received no financial support.
Acknowledgments
We wish to thank all children and adolescents and their families who participated in the study and Prof. Dr. Suna Taneli for guidance and inspiration.
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