The current cross sectional study, it was aimed to estimate the prevalence of Vitamin D deficiency among 110 patients with schizophrenia in Duhok city, who attended the psychiatric Clinic and Department of Azadi teaching hospital. Their total vitamin D level was measured and the result indicated that vitamin D is below the normal level in more than 76% and deficient in 47%.  Statistical analysis of the results showed the presence of a significant difference in incidences between male and female and there were significant increase with the duration of the disease. From the results of the present study concluded that vitamin D deficiency is common in this group of population and most of them were not screened or treated

Jamal B. Mohamed

Sipan S. Haji

Science Journal of University of Zakho

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Journal University of Zakho, Vol. 4(A) , No.1, Pp 32-36, 2016   32ISSN: 2410-7549 THE PREVALENCE OF VITAMIN D DEFICIENCY AMONG PATIENTS WITH SCHIZOPHRENIA IN DUHOK CITY   Jamal Basheer Mohamed and Sipan Sarbast Haji Department of Medicine, College of Medicine, University of Duhok, Kurdistan Region – Iraq. (Accepted for publication: April 14,  2016)   Abstract: The current cross sectional study, it was aimed to estimate the prevalence of Vitamin D deficiency among 110 patients with schizophrenia in Duhok city, who attended the psychiatric Clinic and Department of Azadi teaching hospital. Their total vitamin D level was measured and the result indicated that vitamin D is below the normal level in more than 76% and deficient in 47%.  Statistical analysis of the results showed the presence of a significant difference in incidences between male and female and there were significant increase with the duration of the disease. From the results of the present study concluded that vitamin D deficiency is common in this group of population and most of them were not screened or treated.   Keyword:   Introduction: itamin D is a hormone with the main role on calcium metabolism and keeping bone integrity (Jamilian, et al., 2013). The receptors of Vitamin D are located in different types of cells; the neuronal and glial cells are among them. The enzymes that metabolize Vitamin D are encoded by genes which are expressed in the central nervous system especially the brain (Garcion et al., 2002). Neurogenesis is stimulated by Vitamin D which also it helps in regulation of elements that are neurotrophic, which helps the differentiation of neuronal cells (McCann and Ames, 2007; Brown et al., 2003). Meta-analyses systematic reviews of population-based cross-sectional studies, controlled trials and prospective cohort researches have revealed that lower levels of serum 25-hydroxy vitamin D3 (25-OH D) are related with psychiatric symptoms and depressive disturbances (Ju et al., 2012; Anglin, et al., 2013). Globally around 1 billion person have vitamin D deficiency, it affects all age range and ethnic groups. The incidence are on the increase (Holick et al., 2011). Many recent epidemiological studies support the association between reduced vitamin D levels and psychiatric disturbances in the general population (Maddock, et al., 2013). The previous research from the United Kingdom revealed that vitamin D3 deficiency is related with an elevated risk of some psychologic disturbances in adulthood. Moreover, Cognitive and memory impairment are linked to vitamin D deficiency (Llewellyn et al., 2008; Lee et al., 2009). Low vitamin D level is also common in patient with schizophrenia and depression in adulthood (Llewellyn et al., 2010; Ganji et al., 2010). Despite that the importance of the hormone hydroxyvitamine D in schizophrenia has been studied in many epidemiological researches, data are still inconsistent. In a cohort study in Finland, vitamin D supplement was given during the first months after birth, later on showed that incidence of schizophrenia were reduced in the childhood and adult life (Milaneschi et al., 2010). A Danish study showed that neonate with vitamin D deficiency has a double risk of having schizophrenia in the later life (Hoang et al., 2011). Many researchers found that  the prevalence of vitamin D deficiency is more common in adult suffering from schizophrenia and they found that the incidence is twice more common than in the general population, but it was not clear which condition predispose to the other (McGrath et al., 2004). However, there were no significance relations in some other studies (McGrath et al., (2010). Few studies showed that incidence of schizophrenia are higher in patient with high serum vitamin D levels (Itzhaky et al., 2012). However, the exposure to sunlight by schizophrenic patients didn't show any improvement of their disease (Norelli et al., 2010); Kendell 2002).  The aim of the present study was to examine the prevalence of Vitamin D deficiency among patients with schizophrenia attending the Department of Psychiatry/ Azadi General Teaching Hospital. VJournal University of Zakho, Vol. 4(A) , No.1, Pp 32-36, 2016   33ISSN: 2410-7549 Patients and Methods: This study included 110 patients, who were previously diagnosed to have schizophrenia and attending outpatient clinic and Psychiatric Department at Azadi Teaching Hospital from 15th Jan. 2015 till 20th Feb. 2015. They were investigated for vitamin D level (after obtaining a verbal consent from patients), a blood sample was taken from each subject and Vitamin D level was estimated by ELISA ( ELISA Kit, Roche Company, Switzerland). The results were interpreted as:  Normal         = 30-100 ng/ml Insufficient   =10-29 ng/ml Deficient       = less than 10 ng/ml Toxicity level= more than 100 ng/ml.  Results:   The characteristics of participants are listed in (table 1).  Table (1):  The characteristics of participants    Variables 24.7 yrs Mean age 59 (53.6%) Male patients 51 (46.36%) Female patients 23.74 Mean vitamin D level 5.3 yrs Years of diagnosis of Schizophrenia        From (table 2) different levels of vitamin D is noted according to the years of diagnosis of schizophrenia.  Table (2): The level of vitamin D according to depending the years of diagnosis of schizophrenia  p. value Vitamin D levels No. of patient Percentage    More than 5yrs  Less than 5 yrs  0.006  Normal  6(23.07%)  20(76.92%)  0.077  Insufficient  11(34.37%)  21(65.62%)  0.267  Deficient  30(57.69%)  22(42.3%)  The results presented in (table 3) shows that Vitamin D level in schizophrenic patients differs according to gender. Table (3): Vitamin D level according to gender p.value No. of female No. of male Total Vitamin D Levels 0.019  7 (26.92%)  19(73.07%) 26(23.6%)  Normal  0.013  9(28.12%)  23(71.87%)  32(29.09)  Insufficient  0.052  33(63.46%)  19(36.53%)  52(47.27%)  Deficient   49  61  110  Total Journal University of Zakho, Vol. 4(A) , No.1, Pp 32-36, 2016   34ISSN: 2410-7549 In this study 110 patients who are diagnosed cases of schizophrenia attending psychiatric consultation and department were randomly included in the current study, the mean age was 24.7 years and 59(53.6%) of them were male none of them were previously tested for or treated with vitamin D. Only 26 patients(23.6%) had normal vitamin level but were in the near lower normal limit. Vitamin D was found to be lower than normal levels in 84(76.36%) of patients, and was deficient in 52(47.27%) patients. These results were statistically highly significant. In the present study, female have double incidences (68%) of vitamin D deficiency compared with male patient (28.8%), which was statistically highly significant (P. value =0.0012). Among 110 patients, 49 of them have schizophrenia for more than 5 years and found to be Vitamin D deficient and was more prevalent (67,34%) among those group when compared with (31.14%)  those who have the disease for less than 5 years (31.14%). The statistical difference between them was highly significant (P=0.002).   Discussion: The result of the present study showed a high prevalence of vitamin D deficiency among schizophrenic patients. The result agree with the study that conducted by Valipour et al., (2014). They found that are association between vitamin D deficiency and schizophrenia was very strong. On other hand, (Kesby et al., 2011) found that the average level of vitamin D was lower in schizophrenic patients as compared with the normal subjects, and schizophrenic patients have higher prevalence of vitamin D deficiency. Furthermore, people with vitamin D deficiency have higher risk of developing schizophrenia (Kiraly et al., 2006). The result of this study indicate a high prevalence of vitamin D deficiency and this was similar to the result of the study conducted by Belvederi, et al., (2013);  Itzhaky et al., (2012); Jamilian, et al., (2013). In the current study no relationship was found between the severity of schizophrenia and the levels of deficiency of vitamin D. This was the same observation found by (Crews, et al., 2013). Patients with schizophrenia had significantly lower vitamin D levels when compared with levels of the general population and some studies showed that the incidence was doubled (Valipour, et al., 2014). The incidence of vitamin D deficiency increases with the increased duration of  schizophrenia especially after 5 years of diagnosis and also we found that female patients have significantly higher incidence of vitamin D deficiency. This may be because of social customs and female clothing leading to reduced times of exposure to sunlight. The results of the present study concluded that there was high prevalence of vitamin D deficiency among patients with schizophrenia and the incidences were much higher in female and the incidence increase with the duration of the disease.   References Anglin, R., Samaan, Z., Walter, S., & McDonald, S. (2013). Vitamin D deficiency and depression in adults: systematic review and meta - analysis. The British Journal of Psychiatry, 202(2), 100-107.  Belvederi Murri, M., Respino, M., Masotti, M., Innamorati, M., Mondelli, V., Pariante, C., & Amore, M. (2013). Vitamin D and psychosis: Mini meta-analysis. Schizophrenia Research, 150(1), 235-239.  Brown, J., Bianco, J., McGrath, J., & Eyles, D. (2003). 1,25 Dihydroxyvitamin D3 induces nerve growth factor, promotes neurite outgrowth and inhibits mitosis in embryonic rat  hippocampal  neurons. Neuroscience Letters, 343(2), 139-143.  Crews, M., Lally, J., Gardner-Sood, P., Howes, O., Bonaccorso, S., &  mith, S. et al. (2013). Vitamin D deficiency in first episode psychosis: A case–control study. Schizophrenia Research, 150(2-3), 533-537.  Garcion, E., Wion-Barbot, N., Montero-Menei, C., Berger, F., & Wion, D. (2002). New clues about vitamin D functions in the nervous system. Trends In Endocrinology & Metabolism, 13(3), 100-105.  Ganji, V., Milone, C., Cody, M., McCarty, F., & Wang, Y. (2010). Serum vitamin D concentrations are related to depression in young adult US population: the Third National Health and Nutrition Examination Survey. Int Arch Med, 3(1), 29.  Holick, M., Binkley, N., Bischoff-Ferrari, H., Gordon, C., Hanley, D., & Heaney, R. et al. (2011). Evaluation, Treatment, and Journal University of Zakho, Vol. 4(A) , No.1, Pp 32-36, 2016   35ISSN: 2410-7549 Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 96(7), 1911-1930. Hoang, M., DeFina, L., Willis, B., Leonard, D., Weiner, M., & Brown, E. (2011). Association between Low Serum 25-Hydroxyvitamin D and Depression in a Large Sample of Healthy Adults: The Cooper Center Longitudinal Study. Mayo Clinic Proceedings, 86(11), 1050-1055.  Itzhaky D, Amital D, Gorden K, Bogomolni A, Arnson Y, Amital H. (2012). Low serum vitamin D concentrations in patients with schizophrenia. IMAJ, 14(2), 88–92.   Jamilian, H., Bagherzadeh, K., Nazeri, Z., & Hassanijirdehi, M. (2013).Vitamin D, parathyroid hormone, serum calcium and phosphorus in patients with schizophrenia and major depression.International Journal Of  Psychiatry In Clinical Practice, 17(1), 30-34.  Ju, S., Lee, Y., & Jeong, S. (2012). Serum 25-hydroxyvitamin d levels and the risk of depression: A systematic review and meta-analysis. J Nutr Health Aging, 17, 447–455. Kendell, R. (2002). Exposure to sunlight, vitamin D and schizophrenia. Schizophrenia Research,54(3), 193-198.  Kesby, J., Eyles, D., Burne, T., & McGrath, J. (2011). The effects of vitamin D on brain development and adult brain function. Molecular and Cellular Endocrinology, 347(1-2), 121-127.  Kiraly, S., Kiraly, M., Hawe, R., & Makhani, N. (2006). Vitamin D as a Neuroactive Substance: Review. The Scientific World JOURNAL, 6, 125-139.  Llewellyn, D., Langa, K., & Lang, I. (2008). Serum 25-Hydroxyvitamin D Concentration and Cognitive Impairment. Journal Of Geriatric Psychiatry And Neurology, 22(3), 188-195.  Lee, D., Tajar, A., Ulubaev, A., Pendleton, N., O'Neill, T., & O'Connor, D. et al. (2009). Association between 25-hydroxyvitamin D levels and cognitive performance in middle-aged and older European men.Journal Of Neurology, Neurosurgery & Psychiatry, 80(7), 722-729.  Llewellyn, D., Lang, I., Langa, K., & Melzer, D. (2010). Vitamin D and  Cognitive Impairment in the Elderly U.S. Population. The Journals Of Gerontology Series A: Biological Sciences And Medical             Sciences, 66A(1), 59-65.  Maddock, J., Berry, D., Geoffroy, M., Power, C., & Hyppönen, E. (2013). Vitamin D and common mental disorders in mid-life: Cross-sectional and prospective findings. Clinical Nutrition, 32(5), 758-764.  McCann, J., & Ames, B. (2007). Is there convincing biological or behavioral evidence linking vitamin D deficiency to brain dysfunction?. The FASEB Journal, 22(4), 982-1001.  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. Schizophrenia Research, 67(2-3), 237-245.  McGrath, J., Eyles, D., Pedersen, C., Anderson, C., Ko, P., & Burne, T. et al. (2010). Neonatal Vitamin D Status and Risk of Schizophrenia. Arch Gen Psychiatry, 67(9), 889-8894  Milaneschi, Y., Shardell, M., Corsi, A., Vazzana, R., Bandinelli, S., Guralnik, J., & Ferrucci, L. (2010). Serum 25-Hydroxyvitamin D and Depressive Symptoms in Older Women and Men. Endocrinology, 151(6), 2958-2959.  Norelli, L., Coates, A., & Kovasznay, B. (2010). A comparison of 25-hydroxyvitamin D serum levels in acute and long-stay psychiatric inpatients: A preliminary investigation. E-SPEN, The European E- Journal Of Clinical Nutrition And Metabolism, 5(4), e187-e189.  Valipour, G., Saneei, P., & Esmaillzadeh, A. (2014). Serum Vitamin D Levels in Relation to Schizophrenia: A Systematic Review and Meta-Analysis of Observational Studies. 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The Prevalence of Vitamin D Deficiency Among Patients With Schizophrenia in Duhok City

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The Prevalence of Vitamin D Deficiency Among Patients With Schizophrenia in Duhok City

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