Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Department of Psychiatry, Changshou Third People's Hospital, Changshou, 401231, Chongqing, China.
BMC Psychiatry. 2023 Mar 1;23(1):129. doi: 10.1186/s12888-023-04631-0.
Subacute combined degeneration of the spinal cord (SCD) is mainly caused by deficiency of Vitamin B12 and characterized by deep hypoesthesia, sensory ataxia and spasmodic paralysis of lower limbs. SCD often accompanies with megaloblastic anemia. Psychiatric symptoms could be the initial manifestations of SCD by lack of Vitamin B12, but are rarely considered secondary to physical discomfort and psychological factors in SCD. Additionally, treatment experience for psychiatric symptoms in SCD remains little reported.
We presented a case of a 37-year-old female who complained of being persecuted and controlled for one week and thus was admitted to the psychiatry department. Before that, she had went through persistent paresthesia and numbness of her lower extremities for two-month. Low Vitamin B12 level and hemoglobin concentration, neurologic symptoms and bone marrow smear results supported the clinical diagnosis of SCD and megaloblastic anemia. With supplementation of Vitamin B12 and blood transfusion and short-term prescription of antipsychotics and antidepressants, physical symptoms were improved and psychological symptoms disappeared within 2 weeks.
Psychiatric symptoms of SCD could be generated from lack of Vitamin B12, anemia and neurologic symptoms, where short-term use of antipsychotics and antidepressants may be effective.
脊髓亚急性联合变性（SCD）主要由维生素 B12 缺乏引起，其特征为下肢深感觉缺失、感觉性共济失调和痉挛性瘫痪。SCD 常伴有巨幼细胞性贫血。SCD 中缺乏维生素 B12 可能以精神症状为首发表现，但很少考虑到 SCD 中躯体不适和心理因素的继发作用。此外，SCD 中精神症状的治疗经验报道较少。
我们报告了一例 37 岁女性患者，她因被人迫害和控制感而抱怨了一周，从而被收入精神科。在此之前，她已经经历了持续两个月的下肢感觉异常和麻木。低维生素 B12 水平和血红蛋白浓度、神经症状和骨髓涂片结果支持 SCD 和巨幼细胞性贫血的临床诊断。通过补充维生素 B12、输血以及短期使用抗精神病药和抗抑郁药，躯体症状在 2 周内得到改善，心理症状消失。
SCD 的精神症状可能由维生素 B12 缺乏、贫血和神经症状引起，短期使用抗精神病药和抗抑郁药可能有效。
