Vitamin D supplementation does not improve mental outcomes in adults with early psychosis

1. In this study, vitamin D supplementation in patients with first-episode psychosis did not lead to improved psychotic symptoms.

2. Black patients with first-episode psychosis had higher prevalence of vitamin D deficiency compared to white patients.

Evidence Rating Level: 1 (Excellent)

Patients with psychotic disorders can be at risk of vitamin D deficiency due to poor general health associated with sedentary lifestyles, less sun exposure, and poor nutrition. Specifically, 42% of patients with first-episode psychosis (FEP) were found to have vitamin D deficiency, with higher vitamin D levels at first presentation being associated with fewer symptoms of psychosis a year later. However, whether supplementation of vitamin D in these patients during first-episode psychosis (FEP) can improve mental and health outcomes has not been well studied.

This randomized control study examined 149 adults (59.7% male) aged 18-65, who were within 3 years of their first presentation of a psychotic disorder. Patients were from five different centers in the United Kingdom and were randomized to receive monthly supplement of 120,000 IU of Vitamin D or placebo. Patients who were currently taking Vitamin D supplements >400IU per day or cardiac glycosides, calcium channel blockers, corticosteroids, bendroflumethiazide, isoniazid, rifampicin, or had known calcium, parathyroid, liver, or renal dysfunction and malignancy were excluded. The primary outcome was number of psychotic symptoms as measured by total Positive and Negative Syndrome Scale (PANSS) score at 6 months. Secondary outcomes included other health outcomes such as level of function, depression scores, body mass index, glycated hemoglobin, total cholesterol, and C-reactive protein.

Of note, many patients at baseline were found to have very low Vitamin D levels, especially Black participants (93.4%) compared to White participants (60.5%). However, after 6 months, vitamin D supplementation did not lead to statistically significant improvement of all primary or secondary outcomes measured. This study was potentially limited by monthly dosing of Vitamin D instead of daily dosing, which is thought to be more therapeutically effective. Nonetheless, this study was significant in suggesting that supplementation with Vitamin D alone did not modulate mental and health outcomes in patients with FEP, and how Public health strategies could further explore replenishing vitamin D in vulnerable populations.

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Click to read the study in JAMA Network Open

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