Successful Treatment of Megaloblastic Mania with Cobalamin in a Patient with Pernicious AnemiaAuthor(s): David R. Spiegel , Stephanie West
While secondary mania is relatively uncommon, general medical conditions with potential effects on the central nervous system can lead to a clinical picture indistinguishable from primary mania. Our patient was admitted in a “manic state,” with no prior psychiatric history and of relatively advanced age. Despite various etiologies either ruled out or treated (including drug- and alcohol-induced state, hyperthyroidism and direct central nervous system pathology), low vitamin B12 levels and its subsequent replacement ultimately resulted in attenuation of our patient’s symptoms of mania with psychosis. Cobalamin (vitamin B12) deficiency is usually associated with the triad of neurologic changes, glossitis and macrocytic anemia. It is also widely accepted as a cause for reversible dementia (1). Even though there is also growing evidence of reversible psychiatric symptoms caused by vitamin B12 deficiency, there are few cases of mania reported in current literature. The mechanism behind the mania is even more of a mystery. Treatment with vitamin B12 has been shown to completely reverse the mania in these cases. This case report discusses a woman with mania whose diagnosis was difficult to establish due to multiple medical problems, but was ultimately determined to have pernicious anemia.