Thyroid dysfunction in patients of depression and anxiety and response to therapy

Background: Depression and anxiety are the most common psychiatric presentation in thyroid dysfunction. Aim of the study was to determine the thyroid profile in patients with depressive and anxiety symptoms and to determine the change in symptoms with correction of thyroid profile.Methods: This longitudinal observational study was conducted in patients presented with depressive or anxiety symptoms who visited the psychiatry out patient department (OPD) first time. Two groups were made based on the serum thyroid profile. First group, (n=27) was patients with depression and anxiety with hypothyroidism (experimental group) and second was (n=123) without hypothyroidism (control group). Experimental group, (n=27) was then exposed to thyroxine, 15 patients came for first follow up and 11 patients came for second follow up.Results: The 63% of patients in the experimental group and 62.6% of patients in the control group were of female gender, 66.7% and 33.3% of patients in the experimental group had depressive disorder and anxiety disorder respectively. TSH level of 11 patients of experimental group had significantly less value in first follow up compared to entry point (p=0.002). Generalized anxiety disorder (GAD) 7 scores were significantly lower in first and second follow up than that of the entry point in 11 patients of experimental group (p=0.008, 0.016 respectively).Conclusions: Many patients of the clinical diagnosis of depression (17.6%) and clinical diagnosis of anxiety (18.75%) had hypothyroidism during the first visit to the psychiatry OPD. There was significant reduction in the hypothyroid patients of the serum thyroid stimulating hormone (TSH) value and anxiety scores during the follow up after treatment with levothyroxine

Relationship between serum vitamin B12 level, sociodemographic variables, and medical comorbidity in psychiatric in-patients

Background: To compare serum vitamin B12 levels in psychiatric in-patients and their caregivers and, to study the relationship between psychiatric diagnosis and vitamin B12 levels in psychiatric in-patients.Methods: Adult psychiatric in-patients (n=103) and their adult caregiver (n=103) were enrolled in the present cross-sectional study. All participants underwent estimation of serum vitamin B12, complete blood counts, mean corpuscular volume (MCV), serum folate, and serum ferritin.Results: Vitamin B12 deficiency was found more frequently (60.2%) in psychiatric patients compared to their caregiver (3.9%) (p=0.000). Psychiatric in-patients were significantly younger in age, with a lower level of serum vitamin B12 and folate, fewer numbers of polymorphs, and more numbers of lymphocytes in their peripheral compared to their caregivers. There was no statistically significant difference in socio-demographic variables such as food habit, gender, residence (rural/urban), and occupation between those patients who were deficient and those who were non-deficient in vitamin B12. There was no statistically significant difference between the psychiatric diagnoses and comorbidities in patients with and without vitamin B12 deficiency.  Patients with vitamin B12 deficiency were also not different in terms of their psychiatric diagnosis and associated comorbidities when compared with the patient without vitamin B12 deficiency.Conclusions: Around 60% of psychiatric inpatients have low serum vitamin B12 levels. Lifestyle-related factors and chronic medical illness likely contribute to vitamin B12 deficiency in psychiatric in-patients. Adult psychiatric patients with other medical comorbidities should be screened for vitamin B12 deficiency.