Vitamin D status of psychiatric inpatients at a community teaching hospital in the Midwest.

BACKGROUND: Vitamin D deficiency is a re-emerging epidemic in North America. It is increasingly linked to the pathology of cognition and mental illness and is also common in psychiatric patients. AIMS: This study was designed to determine the prevalence of vitamin D deficiency among psychiatric inpatients in Kansas City, to explore the association between vitamin D status and clinical characteristics, and to identify the association of medical problems related to vitamin D deficiency in mental illness. METHODS: In this descriptive study we recruited 52 psychiatric inpatients at a community teaching hospital in Kansas City between August and November 2013. A vitamin D-deficient state was defined as serum 25-hydroxyvitamin D (25-(OH) D) level ≤ 20 ng/mL. In addition to descriptive statistics, the Student t-test and Pearson test were used in the study. RESULTS: A total of 15 patients (28.8%) were classified as deficient, 20 patients (38.5%) had an insufficiency, 17 patients (32.7%) were categorized as sufficient. Interestingly, there was a statistically significant difference in 25-(OH) D levels between African Americans and Caucasians (t = -2.216, p = 0.03) but no significant relationship between 25-(OH) D level and gender, major psychiatric diagnoses, type 2 diabetes mellitus or obesity. There was also no correlation between 25-(OH) D level and age, body mass index or haemoglobin A1C. CONCLUSIONS: Low 25-(OH) D level was found in a high percentage of psychiatric inpatients in Kansas City. Screening for vitamin D deficiency could be a routine work-up for psychiatric inpatients. Vitamin D supplement for African American inpatients with low vitamin D levels could be considered.

Role of mirtazapine in the treatment of antipsychotic-induced akathisia.

OBJECTIVE: To evaluate the role of mirtazapine in the treatment of antipsychotic-induced akathisia. DATA SOURCES: MEDLINE (1966-February 2008) and PsycINFO (1967-February 2008) were searched using the terms akathisia and mirtazapine. A bibliographic search was conducted as well. STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the search were evaluated. All primary literature was included in the review. DATA SYNTHESIS: Antipsychotic-induced akathisia can be difficult to manage and may respond to mirtazapine based on its antagonist activity at the serotonin 5-HT(2A)/5-HT(2C) receptors. Three case reports (N = 9 pts.), 1 placebo-controlled trial (N = 26), and 1 placebo- and propranolol-controlled study (N = 90) that evaluated mirtazapine for antipsychotic-induced akathisia have been published. Mirtazapine demonstrated a response rate of 53.8% compared with a 7.7% response rate for placebo, based on at least a 2-point reduction on the Barnes Akathisia Scale (global subscale; p = 0.004). Using the same criterion, mirtazapine and propranolol demonstrated efficacy based on response rates of 43.3% and 30.0% compared with placebo (6.7%; p = 0.0051). Mirtazapine was better tolerated than propranolol. In both studies, drowsiness was the most common adverse event associated with mirtazapine. CONCLUSIONS: Mirtazapine may be considered a treatment option for antipsychotic-induced akathisia. It may be especially useful for patients with contraindications or intolerability to beta-blockers and for those with comorbid depression or negative symptoms. Additional studies should be conducted to provide further evidence of mirtazapine's effectiveness in treating akathisia.