a panic attack and lack of vitamin b A case study

[hudsonv]

I have a patient that in his first consultation said that he suffered from many years from panic . Acording to him , his panic atacks lasted for 50 minutes to more than an hour. During this panic episodes, he had symptoms of despersonalization, desrealization, had an allucination that a poison was passing through all his veins, had involuntary movements of his lips and become extremely agitaded, nervous , angry and suicide ideas came up with all of these. I realized that this was not a real panic episode, and realized that this could be a non convulsional epileptic status. All his exams are unremarkable, except consideralble low dose of piridoxin. Has anyone heard in the literature lack of vitamin b causing symptoms similar to these ?. He said that he has been having problems with lack of vitamin b since adolescence and he usulaly needs to take supplents of vitamins

[Horza2002]

http://www.bupa.co.uk/health-information/directory/v/anaemia-b12

 

This does say that Vitamin B deficiency can adversally affect your nevers...so it is possible that could explain some of the symptoms your patient is suffering from.

 

Piridoxin is more commonly known as Vitamin B6. I know that Vitamin B6 is important in the biosynthesis of serotonin, epinephrine and dopamine hormones.

[Marat]

Since vitamin B6 supplementation is essentially harmless, it would be easy to test the hypothesis. But usually neurological symptoms arising purely from some physiological cause are not adorned with such elaborate ideation about things like poison flowing through the patient's veins, etc., so it could be that the hypovitaminosis is unmasking some underlying psychiatric problem or that there is really just a psychiatric problem here and the vitamin deficiency is just a red herring.

[PhDwannabe]

That's pretty damned odd. You're right--it's definitely not your garden variety panic attack, I'll tell you that much. Derealization is possible during panic states, but it's not often prominent, and generally not accompanied by hallucinatory experiences. We're usually talking about people just feeling a bit unreal and disconnected. I'm also not familiar with status epilepticus being associated with so many positive symptoms (e.g., florid nuttiness) as opposed to predominant negative symptoms (e.g., stupor.)

 

Certainly, pretty nutty-sounding delusional and psychotic states can be caused by a number of physiological conditions, but I guess I don't know enough about the metabolism of this particular substance (over what sort of timeframe do its mechanisms become manifest, most basically) to know whether hypovitaminosis would have such dramatic acute effects. I have heard of a relationship between B12 deficiency and a number of psychiatric concerns including psychosis, but not B6.

The one thing that comes to mind is that pyridoxine is one precursor among many for the lengthy chains of reactions which synthesize all sorts of neurotransmitters--dopamine included. However, it's high dopamine levels that tend to be more implicated in psychotic states, not the lower ones we (might) expect to find when a component like this is missing. So, that's the opposite direction we want to go in, here. I guess we may be looking at some sort of more complicated causal series, whereby some other unknown state is depressing pyrodoxine levels as well as producing psychosis. I suppose a regimin of controlled and regularly-assessed supplementation would let you know if the pyrodoxine level was really causal here, depending on whether or not these "attacks" continued.

 

If I know half of what I'm talking about: in general, such quick, transient psychotic experiences do typically have organic causes. The closest "psychological" thing I can think up would be a re-experiencing event in a pretty severe case of PTSD. Obviously, this isn't anything close to that. That said, we could always be looking at both: the substratum of a pathophysiological condition, twisted around into a very odd presentation by an accompanying psychological/psychiatric condition. People with something on the schizophrenia spectrum--schizotypal personality disorder comes to mind at the moment--can give some pretty odd symptom reports of physiological occurrences, since they often experience reality in a fairly odd way. Tangled web we weave, here.

[Marat]

Also, where did this patient present? Just as you don't want to rush to a diagnosis of elephantiasis in Nebraska, so too in most of the Western world you would not naturally suspect such severe vitamin deficiencies as would encourage a diagnosis of Beri-Beri or anything like that. Most people in the West have adequate vitamin supply in the diet.

[random]

It is rather common in less developed countries for deficiencies to cause symptoms that on the surface appear to be a severe mental illness however when proper nutrition is provided quite often (more often than not) it is realized the psychosis or other odd behaviour was an acute reaction. This is very common where there is not an adequate meat supply, upon consuming meat the symptoms go away.

 

It is my personal belief that in our more developed countries these potential causes are often over looked, and purely for the reason another user stated, Because it's not expected, Stress often causes loss of appetite, lack of nutrition renders the body less capable of handling stress, (so even more susceptible) therefore the body responds and presents symptoms commonly associated with mental illness,

 

So I don't know how much that helps but it is my perspective.