Electronic Letters to:

Original papers:
Eleanor Tiangga, Asha Gowda, and John A. Dent
Vitamin D deficiency in psychiatric in-patients and treatment with daily supplements of calcium and ergocalciferol
Psychiatr Bull 2008; 32: 390-393 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read eLetter] Vitamin D deficiency in psychiatric inpatients
Rayin N Kulambil Padinjakara, Fabida Noushad CT3 General Adult Psychiatry, Coventry and Warwickshire Partnership NHS Trust   (9 October 2008)
[Read eLetter] Vitamin D deficiency and mental illness
Vishelle Kamath, Samir Shah ST 3 Psychiatry Manchester Mental Health and Social Care NHS Trust, Roshelle Ramkisson ST 3 Psychiatry Greater Manchester West Mental Health NHS Foundation Trust   (27 October 2008)

Vitamin D deficiency in psychiatric inpatients 9 October 2008
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Rayin N Kulambil Padinjakara,
Specialist Registrar, Diabetes and Endocrinology
University Hospitals Coventry and warwickshire NHS Trust,
Fabida Noushad CT3 General Adult Psychiatry, Coventry and Warwickshire Partnership NHS Trust

Send letter to journal:
Re: Vitamin D deficiency in psychiatric inpatients

rayin.padinjakara{at}uhcw.nhs.uk Rayin N Kulambil Padinjakara, et al.

It is not surprising that Eleanor Tiangga et al found lower levels of vitamin D in long stay psychiatric patients who are at high risk of developing vitamin D deficiency.

Although 25-hydroxy vitamin D measurement is the gold standard for diagnosing the problem, it is done in specialist laboratories and often the results will take weeks to come back. On a wider scale it useful to do basic lab tests like serum calcium, phosphate and parathyroid hormone levels. Raised parathyroid hormone levels along with low normal calcium level are the most common metabolic abnormality in vitamin D deficiency. These tests are cheaper and easily done in most hospitals with results coming back within a week.

If the above mentioned metabolic pattern is found patients could be started on calcium and vitamin D tablets after sending a blood sample for vitamin D levels.

A good source of vitamin D for preventive purposes is cod liver oil. Most of the commercially available cod liver oil capsules provide 100% RDA (recommended daily allowance) of vitamin D and vitamin A with added benefit of omega 3 fatty acids!

Reference

ELEANOR TIANGGA, ASHA GOWDA, JOHN A. DENT (2008) Vitamin D deficiency in psychiatric in-patients and treatment with daily supplements of calcium and ergocalciferol. Psychiatric bulletin, 32, 390-393

Declaration of interest - None

Authors

Fabida Noushad, CT3 General Adult Psychiatry, Coventry and Warwickshire Partnership NHS Trust

RN Kulambil Padinjakara, Specialist Registrar, Diabetes and Endocrinology, University Hospitals Coventry and Warwickshire NHS Trust, Walsgrave, Coventry, CV2 2DX, email: rayin.padinjakara@uhcw.nhs.uk

Vitamin D deficiency and mental illness 27 October 2008
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Vishelle Kamath,
Specialist Registrar in Old Age Pscyhiatry
Cambridgeshire and Peterborough Foundation NHS Trust,
Samir Shah ST 3 Psychiatry Manchester Mental Health and Social Care NHS Trust, Roshelle Ramkisson ST 3 Psychiatry Greater Manchester West Mental Health NHS Foundation Trust

Send letter to journal:
Re: Vitamin D deficiency and mental illness

drshah1978{at}gmail.com Vishelle Kamath, et al.

Dear Sir,

Tiangga et al. have concluded that male psychiatric inpatients appear to be at risk of Vitamin D deficiency. We would like to draw your attention to two further groups of mental health service users namely women and the elderly who are vulnerable to the same risk with adverse consequences.

A cross section of older adults selected from a longitudinal study of memory and ageing suggested that Vitamin D deficiency was associated with low mood and impairment in measures of cognitive performance (1). It is worth noting that the prevalence of Vitamin D deficiency in all adults in the UK is about 14.5% and rises to more than 30% in those over 65 years of age. (3) An integrative review on Vitamin D and mood disorder in women, showed the results in four out of six studies demonstrated significant association between low 25 Hydroxyvitamin D levels and higher levels of mood disorder which included premenstrual syndrome, seasonal affective disorder, non specific mood disorder and major depressive disorder (2).

The high prevalence rate of Vitamin D deficiency, the avoidable complications and positive outcomes of treatment suggest that Vitamin D deficiency should be addressed through public health measures. Effective preventative measures should be considered along with exploring detection and treatment.

A simple preventative measure in the UK is the exposure of the body to sub thermal doses of sunlight for 15 minutes twice or three times weekly from April to September, which should result in sufficient skin synthesis of Vitamin D (3). This simple measure can be implemented in mental heath units at no additional cost or harm to patients.

References:

1. Consuelo H. Wilkins, M.D., Yvette I. Sheline, M.D., Catherine M. Roe, Ph.D., Stanley J. Birge, M.D., and John C. Morris, M.D., Vitamin D Deficiency Is Associated With Low Mood and Worse Cognitive Performance in Older Adults; American Journal of Geriatric Psychiatry 14:1032-1040, December 2006

2. Murphy PK, Wagner CL; Vitamin D and Mood Disorders Among Women: An Integrative Review; Journal of Midwifery & Women's Health, Volume 53, Issue 5, Pages 440 - 6.

3. Primary vitamin D deficiency in adults; Drug and Therapeutics Bulletin 2006; 44:25-29