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Abstract Methods Results Introduction 1.Belvederi Murri, M., Respino, M., Masotti, M., Innamorati, M., Mondelli, V., Pariante, C. et al. (2013) Vitamin D and psychosis: mini meta-analysis. Schizophr Res 150: 235–239. 2.Crews, M., Lally, J., Gardner-Sood, P., Howes, O., Bonaccorso, S., Smith, S. et al. (2013) Vitamin D deficiency in first episode psychosis: a case–control study. Schizophr Res 150: 533–537. 3.Lawrie, S. and Abukmeil, S. (1998) Brain abnormality in schizophrenia. A systematic and quantitative review of volumetric magnetic resonance imaging studies. Br J Psychiatry 172: 110–120. 4.McGrath, J., Saari, K., Hakko, H., Jokelainen, J., Jones, P., Järvelin, M. et al. (2004) Vitamin D supplementation during the first year of life and risk of schizophrenia: a Finnish birth cohort study. Schizophr Res 67: 237–245. Contact Information S Faiz Qadri, M.D. Department of Psychiatry, Creighton University and CHI Health, 415 S 25 th Avenue, Omaha, NE 68131. Tel (402) 717-5320. FaizQadri@creighton.edu. Conclusions Inclusion criteria: Premenopausal women and men with a diagnosis of Schizophrenia as determined by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID- I). Currently on either olanzapine and/or clozapine for a minimum duration of 2 years. Exclusion criteria: Exclusion criteria included concurrent DSM-IV Axis I diagnosis such as lifetime Bipolar I Disorder, Major Depressive Disorder [except if secondary to Schizophrenia], history of Eating disorders or current Alcohol Dependence or Abuse. Study Design: Cross sectional study design. Twenty five patients, 22 males and 3 premenopausal females with Schizophrenia or Schizoaffective disorder on antipsychotic therapy for a minimum duration of two years were included. Eligible subjects underwent a physical examination including height, weight, body mass index (BMI) evaluation and asked to fill out a 3 day calcium intake dairy. The exposure to antipsychotic medications over the past 2 years was calculated and expressed as chlorpromazine equivalents (CPZ). Overnight fasting serum levels of serum 25 hydroxyvitamin D were measured. Vitamin D Insufficiency In Chronic Schizophrenia S. Faiz Qadri, MD 1,2 Sriram Ramaswamy,MD 1 1 Department of Psychiatry, Creighton University, Omaha, NE, Behavioral Health, Catholic Health Initiatives 2, Omaha, NE Background: Vitamin D plays a crucial role in neuroprotection and neurodevelopment and low levels reported to be associated with schizophrenia. The aim of this study was to examine serum 25 hydroxyvitamin D concentrations in patients with chronic schizophrenia. Methods: Premenopausal women and men between 19 and 60 years of age, with diagnosis of schizophrenia, who had received olanzapine and/or clozapine therapy for a minimum duration of 2 years were recruited into the study [n=25]. Eligible subjects underwent a physical examination including height, weight, body mass index (BMI) evaluation and asked to fill out a 3 day calcium intake dairy. Serum levels of serum 25 hydroxyvitamin D were measured. Results: A total of 25 subjects (22 male and 3 female) participated in this study. Overall, their mean (SEM) age was 46.28 years (+/- 9.8), body mass index (BMI) was 31.02 kg/m2 (+/- 5.34). Mean daily vitamin D intake from food sources alone was 4,43mcg (+/- 3.19) and calcium intake from food sources alone was 946.84mg (+/-458.92) daily. 10 patients (42%) were non-smokers and 14 (58%) of them were smokers. Using a cutoff of 20 ng/mL, 9 study subjects (36%) had Vitamin D deficiency. The prevalence of vitamin D insufficiency increased to 48% (11 of 25 patients) using the 30 ng/mL cutoff. The highest serum 25(OH)D concentration observed was 57 ng/ml; the lowest was 8 ng/ml. Calculating the daily vitamin D intake from food sources alone 50% (11 of 24) of these subjects had very low vitamin D intake status <5mcg [200IU]. The intake of other 50% was < 10 mcg. There was no correlation between serum 25(OH)D measured and age, BMI or exposure to antipsychotic medications [CPZ] values. Conclusions: The results of this study demonstrate that all patients with schizophrenia who have been exposed to antipsychotics had insufficient vitamin D intake and 50% of them had insufficient calcium intake. Given the implications of low Vitamin D levels on symptom severity in schizophrenia, cognition and neuroprotection, we recommend aggressive screening for deficiency states, optimizing dietary intake of calcium and considering routine supplementation with Vitamin D in schizophrenia.. Vitamin D plays a crucial role in neuroprotection and neurodevelopment, and low levels reported to be associated with schizophrenia. McGrath et al reported that low prenatal vitamin D (especially during the third trimester) may be a risk factor for development of schizophrenia in offspring. Similarly, a Finnish study showed that a lack of vitamin D supplementation during the first year of life correlated with an increased risk of developing schizophrenia. There is data linking vitamin D deficiency to structural changes in the brain such as enlarged ventricles (Lawrie et al) and cortical thinning (Selemon et al) that are associated with schizophrenia. Also, higher rates of vitamin D deficiency in people with first episode psychosis were reported in a study by Crews et al. Over the past few years there has been growing recognition of the importance of Vitamin D and its impact on public health. An estimated 1 billion people have inadequate levels of vitamin D in their blood, and deficiencies can be found in all ethnicities and age groups. Bone disease caused by vitamin D deficiency is associated with serum 25(OH)D values below 10 ng/mL. Nowadays, the term vitamin D insufficiency has been used to describe suboptimal levels of serum 25(OH)D that may be associated with extra skeletal conditions and disease outcomes. Vitamin D deficiency has been linked to several disease states such as multiple sclerosis prostate, breast and colorectal cancers. A recent meta-analysis of seven studies on vitamin D and psychosis reported that schizophrenia had a medium effect size for lover vitamin D levels than healthy controls and a trend for lover levels than other psychoses (Belvederi Murri et al). The aim of this study was to examine serum 25 hydroxyvitamin D concentrations in a group of patients with chronic schizophrenia. Chronic schizophrenia is associated with insufficient calcium intake and low serum 25(OH)D concentrations. Although the consequences of vitamin D deficiency upon the skeleton are well known, little is known about the optimal levels for brain function especially in schizophrenia. Given the implications of low Vitamin D levels on symptom severity in schizophrenia, cognition and neuroprotection we recommend aggressive screening for deficiency states, optimizing dietary intake of calcium and considering routine supplementation with Vitamin D in schizophrenia Limitations: Small sample size, cross sectional study design, lack of control group and adjustments for seasonal variations in Vitamin D levels. A total of 25 subjects (22 male and 3 female) participated in this study. Overall, their mean (SEM) age was 46.28 yr (+/- 9.8), body mass index (BMI) was 31.02 kg/m2 (+/-5.34). Mean daily vitamin D intake from food sources alone was 4,43mcg (+/- 3.19) and calcium intake from food sources alone was 946.84mg (+/-458.92) daily. This study population was of mixed race, with 19 reporting their race as white, 1 as Asian, 4 as Black, and 1 as Hispanic (4%). 10 patients (42%) were non-smokers and 14 (58%) of them were smokers. Using a cutoff of 20 ng/mL, 9 study subjects (36%) had Vitamin D deficiency. The prevalence of vitamin D insufficiency increased to 48% (11 of 25 patients) using the 30 ng/mL cutoff. The highest serum 25(OH)D concentration observed was 57 ng/ml; the lowest was 8 ng/ml. Calculating the daily vitamin D intake from food sources alone 50% (11 of 24) of these subjects had very low vitamin D intake status <5mcg [200IU]. The intake of other 50% was < 10 mcg. There was no correlation between serum 25(OH)D measured and age, BMI or exposure to antipsychotic medications [CPZ] values. Graphs References Disclosure: This study was supported by a NARSAD Young Investigator Award to Dr. Sriram Ramaswamy.
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