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Metrics details. Vitamin D deficiency is a re-emerging epidemic, especially in minority populations. Vitamin D is crucial not only for bone health but for proper brain development and functioning. Download b? font ti?ng vi?t full cho win7 levels of vitamin D are associated with depression, seasonal affective disorder, and schizophrenia in adults, but little is known about vitamin D and mental health in the pediatric population. One hundred four adolescents presenting for acute mental health treatment over a month period were assessed for vitamin D status and the relationship of OH vitamin D levels to severity of illness, defined download b?
font ti?ng vi?t full cho win7 presence of psychotic features. Adolescents with psychotic features had lower vitamin D levels The association for vitamin D deficiency and psychotic features was substantial OR 3.
Race was independently associated посетить страницу источник vitamin D deficiency and independently associated with psychosis for those who were Asian or biracial vs. Race was no longer associated with psychosis when the results were adjusted for vitamin D level. Vitamin D deficiency and insufficiency are both highly prevalent in adolescents with severe mental illness. The preliminary associations between vitamin D deficiency and presence of psychotic features warrant further investigation as to whether vitamin D deficiency is a mediator of illness severity, result of illness severity, or both.
Higher prevalence of vitamin D deficiency but no greater risk of psychosis in African Americans, if confirmed, may have special implications for health disparity and treatment outcome research. Peer Review reports. Vitamin D deficiency is endemic across the life span and in diverse populations throughout the world [ 1 ]. Contributing factors are lack of exposure to sunlight and insufficient dietary intake; individuals with darker нажмите сюда are at higher risk due to low cutaneous synthesis and dairy-poor diets.
Vitamin D is well recognized as essential for intestinal calcium absorption, serum calcium homeostasis, optimal skeletal development, and the prevention of rickets and osteoporosis [ 4 ].
The importance of vitamin D to the CNS in both healthy and psychiatric populations is less well-appreciated and is vastly understudied compared to its known impact on bone health. Vitamin D receptors are present throughout the brain, and D-deficiency is associated with negative CNS effects in animal studies [ 5 ]. Vitamin D receptors and activating enzymes are particularly prominent in the hypothalamus and substantia nigra, and are involved in glucocorticoid signaling in hippocampal cells. Depletion models show maternal offspring with abnormal brain shape, cell number, and reduced neurotropic factors and receptors.
Vitamin D receptor animal knock-out models show increased anxiety, decreased activity, and muscular and motor impairments, resembling phenotypic models of depression. Vitamin D is neuroprotective download b? font ti?ng vi?t full cho win7 hippocampal cells, through regulating calcium ion channels and activating PKC and mapPK pathways. Clinical studies reinforce the significance of this basic work.
A Finnish cohort supplemented with prenatal and infant vitamin D demonstrated reduced adult risk for schizophrenia [ 6 ]. Low vitamin D levels were found to correlate with major depression [ 7 ] and premenstrual mood symptoms in women [ 8 ], and mood disorders and cognitive impairment in older adults [ 9 ]. Two randomized controlled trials RCT have shown that raising vitamin D levels improved depression.
The first study examined phototherapy vs. Another RCT of overweight and obese subjects, at greater risk for low vitamin D than those of normal weight, found higher levels of depression with low vitamin D; supplementation resulted in significant improvement in depressive symptoms after one year [ 11 ]. To the best of our knowledge, there have been no published studies examining vitamin D deficiency and the presence of psychosis in adolescents.
We hypothesized that, in severely mentally ill adolescents, defined as adolescents requiring either inpatient or partial hospitalization, 1 rates of vitamin D insufficiency and deficiency would be greater than those documented in general Download b? font ti?ng vi?t full cho win7 populations, and 2 lower vitamin D levels would be associated with mental illness severity, defined as presence of psychotic features. Charts were identified by a clinical admission database of the service.
Psychotic symptoms, defined as hallucinations, paranoia, or delusions, were documented on pc beta download city vice stories edition gta 2 admission assessment forms by the emergency room psychiatrist and the admitting attending. The relationship of vitamin D levels and psychosis was assessed with an ANOVA type design and the association of psychosis with vitamin D level groups with logistic regression models, assessing race as well as vitamin D level groups in a multivariate model.
All analyses were carried out using SAS 9. Thirty-five A comparison of demographic variables between adolescents with insufficient, deficient, and normal OH D levels is presented in Table 1. Those who were deficient were more likely to be black or Asian Figure 1 and have psychotic features Figure 2. Figure 3 displays the association of OH vitamin D and the interaction of race and psychosis.
All groups showed lower OH D levels in the presence of psychosis including Asians who were all deficient. Odds ratio comparisons for presence of psychosis with vitamin D deficiency as well as potential covariates, including race and medication exposure, are depicted in Table 2.
The association of psychosis and vitamin D level was significant overall in the univariate and multivariable analyses. Of added interest was the association of psychosis with Vitamin D levels and race Table 3. While race and vitamin D levels were associated, race and psychosis were not associated adjusting for vitamin D levels. Association of psychosis, race, and interaction of psychosis and race on vitamin D level expressed as continuous data. Immediate family history of psychosis and current antidepressant exposure were also independently related to psychosis.
Rates of vitamin D insufficiency and deficiency rose from December through March, peaking in March, as would be expected. This is the first report of an association between vitamin D deficiency in adolescents and severity of mental illness, defined as presence of psychotic features. These findings are similar to a cross-sectional study also linking vitamin D deficiency and adult psychosis [ 13 ].
In a study of over 1, adults from combined cohorts of a longitudinal evaluation of severe mental illness and a population-based sample from the Oslo Health Study, vitamin D levels and presence of psychosis were compared between native Norwegians and dark-complexion immigrants to Norway.
In the adult epidemiologic sample, disorientation on the PANSS, weight loss, and lack of physical energy correlated with lower OH D levels after controlling for major depression. Demographics, level of functioning, lifestyle habits, and BMI were not associated with vitamin D levels. Our findings also agree with an unpublished report of a child and adolescent psychiatric population residing in the Pacific Northwest.
The overall mean OH D level was No differences in mean levels were found between those taking or not taking antipsychotics, indicating that antipsychotics may not lower vitamin D absorption. The prevalence of vitamin D deficiency in our sample of acutely mentally ill adolescents is also greater по этому сообщению the high rates observed in U. Our higher prevalence rates of deficiency and insufficiency may be in part due to the latitude of Rochester, NY, Paris, France is Except during summer months, skin makes negligible vitamin D from sunlight at latitudes above 37 degrees north or below 37 degrees south.
Basic and preclinical animal studies provide clues as to how vitamin D may lower risk for psychosis, and how vitamin D deficiency may raise download b? font ti?ng vi?t full cho win7 for psychosis and depression. These mechanisms include OH vitamin D and calciferol, the renal metabolite of OH D 1,OH D : 1 altering neurotrophic factors and monoamine levels [ 1718 ], resulting in vitamin D-related behavioral phenotypes similar download b? font ti?ng vi?t full cho win7 those for depression and psychosis [ 19 ], 2 facilitating oxidative stress responses [ 20 ], 3 changing multiple neuroendocrine transmitters [ 2123 ], and 4 regulating hormonal and serotonin pathway effects download b?
font ti?ng vi?t full cho win7 the CNS [ 2425 ]. Dietary intake and sunlight exposure as sources of vitamin D are influenced by race. Although not fully comparable due to different methodologies, our mentally ill non-Caucasian population also demonstrates more vitamin D deficiency, and for Asians and biracial subjects a greater rate of psychosis, but not after adjusting for vitamin D level. Small clinical studies to date suggest potential for a causal link between low vitamin D and mood disorders [ 8 — 111626 ], necessitating that randomized controlled trials in carefully defined populations of interest be performed to better characterize the relationship between vitamin D deficiency and risk for depression and psychosis.
In addition to the possibility that vitamin D deficiency contributes to vulnerability to psychosis, other nutritional factors may play a role: adolescents eating a diet low in dairy products may also consume less of other nutrient-rich foods, including those with essential fatty acids.
If a prospective association between psychotic features and vitamin D deficiency is confirmed, outstanding issues include: 1 how vitamin D affects monoamine function and the HPA axis and immune responses to stress and symptom production, 2 whether supplementation can be protective against incident depression or psychosis and their recurrence, and 3 whether supplementation improves symptoms in those with clinically diagnosed depression or psychosis, especially in populations with darker skin [ 26 ].
An open-label Swedish case-series suggests that depression /13633.php improved by vitamin D supplementation in adolescents [ 27 ]. Prevention studies in twilight dawn part 2 in hindi download for offspring would be highly novel. Thus, future studies could target both prevention of mental and comorbid physical illness, focusing on disparity and somatic treatment augmentation.
Normalizing vitamin D levels warrants study in those with severe mental illness to determine whether, and at what dose, vitamin D больше на странице protect against metabolic side effects from psychopharmacologic treatment or reduces the development of comorbid physical illnesses such as diabetes, cardiovascular disease, and osteoporosis. Low vitamin D is associated with greater BMI, insulin resistance, and systolic blood pressure, lower HDL-C in obese adolescents and adults, and lower final height in young adult women [ 328 — 31 ].
Vitamin D status may be especially important in those with serious mental illness as they develop poorer metabolic health at earlier ages. Optimal vitamin D levels also may protect against several different cancers breast, colon, pancreas, and prostateand autoimmune disorders lupus, multiple sclerosis, and Type I diabetes [ 32 ].
Molecular mechanisms of vitamin D that are protective against cancer include reducing cellular oxidative stress [ 33 ]. Vitamin D supplementation may thus represent a low-cost population-based intervention capable of reducing utilization of more intensive physical and mental health treatments; multiple trials are underway assessing impact on a variety of physical health conditions including osteoporosis, insulin resistance, and cardiovascular risk.
How should low vitamin D levels be corrected? Most adolescents, especially those who skip breakfast or are lactose intolerant, do not consume adequate amounts download b? font ti?ng vi?t full cho win7 these foods to maintain optimal vitamin D levels, and cannot meet their requirements through diet alone.
Additional initial supplementation to return deficient individuals to normal may be indicated as dietary reference intake amounts recommended by the IOM may still be insufficient for download b? font ti?ng vi?t full cho win7 health maintenance in many individuals [ 38 ]. The amount appropriate for maintenance of best mental and physical health is therefore controversial, and is unknown in the chronically mentally ill, who may metabolize vitamin D more quickly due to added oxidative stress burden.
This work is limited by a small sample size, cross-sectional method, inpatient sampling bias, and lack of formal research measures for diagnosis and severity of illness, family psychiatric history, sun exposure, and intake of Vitamin D and other dietary nutrients.
No adolescents, however, were taking vitamin Star wars iii the clone pc crack download supplementation. A winter sampling bias is present, potentially contributing to low rates of D-deficiency, however, this does not rule out that seasonal effects in illness severity and admission rates related to greater vitamin D deficiency may occur.
Analysis of ultraviolet radiation for latitudes 0 to 80 degrees N found that for March through October, sites from 18 degrees to 44 degrees N the majority of the continental United States had equal amounts of vitamin D producing ultraviolet light; November through February only demonstrated decreases in vitamin D producing ultraviolet light [ 39 ].
Additional limitations include that adolescents were not screened for osteomalacia; serum parathyroid hormone values were not routinely checked in those who were D-deficient; however, several performed clinically were within normal ranges.
Many confidence intervals are wide; confirmation of these results awaits a large download b? font ti?ng vi?t full cho win7 study and more rigorous design.
Probing smaller enriched clinical samples may be useful in providing biologic signals of relevance in populations with depression, for example, using neurocognitive tasks. Descriptive differences in a clinical population compared with population norms may also provide direction for further investigation related to both interactive effects of mental illness and ancestry.
Vitamin D deficiency is highly prevalent in this descriptive sample of acutely mentally ill adolescents, especially in African-American and Asian teens, and appears related to psychotic symptoms.
This work is the first to report an association between psychosis and vitamin D deficiency in psychiatrically hospitalized adolescents [ 40 ] and confirms download b? font ti?ng vi?t full cho win7 association found previously in an adult population [ 13 ]. Our study also expands on similar deficiency findings from a Parisian inpatient adolescent cohort [ 15 ], providing clinical diagnoses of mood disorders in the great majority of inpatient teens with vitamin D deficiency, and further, finding lower risk for psychosis in the presence of antidepressant treatment.
Both support the possibility that heightened vulnerability to psychotic features occurs in the substantial proportion of teens with mood disorders who are vitamin D deficient. Prospective trials of vitamin D supplementation are needed to address targeted mental health symptom domains as well as metabolic health variables in D-deficient severely mentally ill adolescents and adults, focusing on dose-finding and tolerability.
Calls have been made for clinical monitoring in download b? font ti?ng vi?t full cho win7 with psychiatric illness as well as randomized trials of vitamin D for depression [ 4142 ]. Clinical screening for vitamin D deficiency in severely mentally ill adolescents is justified by their high risk for both chronic mental illness and early onset of cardiometabolic comorbidities, especially as vitamin D deficiency at mid-life appears a strong independent predictor of all-cause download b?
font ti?ng vi?t full cho win7 odds ratios 2. A key clinical question raised by our work and supported by known safety data is whether psychiatrically hospitalized dark-complected adolescents, including African-Americans, Asians, and Muslim females in traditional covered dress, should be routinely supplemented with vitamin D until proven otherwise. Am J Clin Nutr. Arch Pediatr Adolesc Med. Article PubMed Google Scholar. Holick MF: Sunlight and vitamin D for bone health and download b?
font ti?ng vi?t full cho win7 of autoimmune diseases, cancers, and cardiovascular disease. McCann J, Ames B: Is there convincing biological or behavioral evidence linking vitamin D deficiency to brain dysfunction?.
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